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CT of the upper abdomen shows a large water density collection in the right upper quadrant, engulfing the ventriculoperitoneal shunt tubing. The collection exerts mass effect on the adjacent liver. A smaller collection is seen surrounding the shunt in the gallbladder fossa.
The collection had been stable over serial follow-up CT scans spanning 3 years. While biochemical assay of the collection has not been performed at our institution to confirm CSF, the proximity to the shunt makes this most likely.