Intra-axial Hepatic Cerebrospinal Fluid Pseudocyst: An Unusual Complication of Ventriculoperitoneal Shunt Placement
Correspondence Address :
Ramakrishna Narayanan,
14, SBI Colony, Tarbund Sikh Village, Secunderabad, Hyderabad-500009, Telangana, India.
E-mail: drrkris@gmail.com
Intra-abdominal Cerebrospinal Fluid (CSF) pseudocysts are a well-known and potentially serious complication of Ventriculoperitoneal (VP) shunt placement. These cysts are often found within the peritoneal cavity or along the serosal surface of solid organs. Here, we present an unusual case of an intrahepatic CSF pseudocyst in a 14-year-old female patient with a VP shunt placed three years ago, following the excision of a cerebellar pilocytic astrocytoma. The child presented with complaints of right hypochondriac pain and tenderness for one month. On ultrasound of the abdomen, the right lobe of the liver showed a complex anechoic cystic collection with multiple thick internal septations. A Contrast-enhanced Computed Tomography (CECT) examination revealed a well-defined hypodense collection in segments IV and V of the liver with a VP shunt tube within. Based on clinical and imaging features, differentials of intra-axial intrahepatic CSF pseudocyst, complex hepatic cyst, peri-shunt hemorrhagic cyst, and biliary cystadenoma were considered. Aspiration of the cyst revealed clear, colourless, non purulent, non sanguineous fluid which tested positive for beta-2-transferrin, confirming the collection to be a CSF pseudocyst. An elective laparoscopic cyst excision with shunt revision was performed with no recurrence on follow-up. The present case highlights the uncommon occurrence of intrahepatic CSF pseudocysts post-VP shunt, necessitating meticulous diagnostic evaluation. Successful laparoscopic excision and shunt revision underscore the efficacy of tailored interventions. This contribution enhances the understanding of atypical complications in VP shunt recipients, guiding clinicians and radiologists in both diagnosis and management.
Aspiration, Beta-2-transferrin, Cyst excision, Intrahepatic collection
DOI: 10.7860/JCDR/2024/67327.19091
Date of Submission: Sep 08, 2023
Date of Peer Review: Nov 27, 2023
Date of Acceptance: Jan 02, 2024
Date of Publishing: Mar 01, 2024
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Sep 11, 2023
• Manual Googling: Dec 06, 2023
• iThenticate Software: Dec 23, 2023 (12%)
ETYMOLOGY: Author Origin
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