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Heather Borders, MD
over 7 years ago
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CSF Pseudocyst

Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Infectious-Inflammatory
Created: over 5 years ago
Updated: over 5 years ago
Tags: PEDS
Modality/Study Types: US CT
Activities:
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History

9 month old with abdominal distention and lethargy.


Case Images


Diagnosis

CSF Pseudocyst

Findings

CT – Large peritoneal fluid collection displacing bowel anteriorly and to the left.

US – 2 dominant walled off fluid collections; the right-sided collection is relatively anechoic and the left-sided collection is multi-septated.

Discussion

The use of the peritoneal cavity for CSF resorption is primary method of treatment in the shunted hydrocephalus. The most common extracranial complications of ventriculoperitoneal shunting are tube disconnection, tube blockage, and infection. Uncommon complications include abscess, bowel perforation, CSF ascites, pathologic migration of the shunt and pseudocyst formation. Predisposing factors to CSF pseudocyst formation are largely related to inflammation such as infection, peritoneal adhesions, increased CSF proteins, malabsorption of CSF secondary to subclinical peritonitis and allergic response to the peritoneal catheter or to a component of the CSF. Histologically the wall of the pseudocyst is composed of fibrous tissue without epithelial lining and is filled with CSF. Uncomplicated pseudocyst shows uniform fluid attenuation on CT and is nearly anechoic on US; infected pseudocysts are often septated. It is important to identify the shunt tip within the cyst for confident diagnosis.

Reference

Gupta P, Ghole V, Eshaghi N. Abdominal CSF pseudocyst. Applied Radiology 2009; 29-30.



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