HISTORY IMAGING FINDINGS - Case 72 Pseudocyst around.pdf

Juan Carlos Pernas, MD Jordi Catala, MD Case 72: Pseudocyst around Ventriculoperitoneal Shunt1 HISTORY A 32-year-old man presented with abdominal pain, distention, and bloating. His white blood cell count and amylase serum levels were normal. No history of malignancy or pancreatic disease was known to exist. A ventriculoperitoneal shunt had been placed 15 years earlier to treat hydrocephalus secondary to spina bifida. The patient underwent supine abdominal radiography and unenhanced abdominal computed tomography (CT). IMAGING FINDINGS The abdominal supine radiograph (Fig 1) showed mild disten- tion of small-bowel loops in the left upper quadrant. Unenhanced abdominal CT scans showed a mesenteric, thin-walled well-defined cystic mass (Fig 2) around the ven- triculoperitoneal shunt tip. The cystic mass was indepen- dent from the pancreas and encased a small-bowel loop, which was represented by small gas bubbles. Proximal di- lated small-bowel loops could be seen, but there was no colonic obstruction. A diagnosis of peritoneal pseudocyst around ventriculoperi- toneal shunt causing small-bowel obstruction was suspected. Percutaneous drainage was performed (Fig 3), and 300 mL of clear fluid was drained. The immediate postdrainage scan showed that the size of the cystic mass decreased markedly, and the small-bowel ob- struction was relieved in a few hours (Fig 4). The findings at fluid analysis were consistent with cerebro- spinal fluid, with negative cultures and absence of microbian flora. No further procedures were needed to relieve abdominal obstruction. The patient was referred to another hospital for elective surgery, where he underwent shunt replacement and pseudocyst resection. Part 1 of this case appeared 4 months previously and may contain larger images. Index terms: Cerebrospinal fluid, 167.458, 74.3123, 791.458 Diagnosis Please Shunts, ventriculoperitoneal, 167.458, 74.458, 791.458 Published online 10.1148/radiol.2321011976 Radiology 2004; 232:239–243 1 From t