Teaching NeuroImages: Massive abdominal CSFoma
and Department of Anesthesia, Critical Care and Pain Medicine (N.V.K.), Massachusetts General Hospital, Harvard Medical School, Boston, MA.Neurology (Impact Factor: 8.29). 03/2013; 80(13):e146. DOI: 10.1212/WNL.0b013e318289705e
A 31-year-old woman with congenital hydrocephalus status after ventriculoperitoneal shunt placement 23 years earlier presented with abdominal distention. The patient denied fever, headache, or sensory or motor abnormalities. Examination was notable for a tense abdomen. CT of the abdomen and pelvis demonstrated a massive, loculated, CSFoma, or CSF pseudocyst (figure). Ventriculoperitoneal shunts are associated with a variety of complications including tubing disruption, tip blockage, infection, intestinal perforation, tip migration, and CSFoma development.(1) CSFoma is a rare complication, thought to be caused by low-grade shunt infection, chronic inflammation, increased cerebral spinal fluid protein, or peritoneal adhesions, and is estimated to occur in 1.0% to 4.5% of cases, with a typical occurrence within 3 weeks to 5 years of shunt placement.(2,3) Treatment consists of external drainage or surgical excision followed by reconstruction of the shunt system.(4.)
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ABSTRACT: Cerebrospinal fluid (CSF) shunting has been a mainstay in the treatment of hydrocephalus for many decades. With a reported 33,000 shunt placement procedures performed in the US annually, and a lifetime revision rate approaching 50%, abdominal radiologists must be familiar with the typical imaging appearance of an array of shunt complications. Complications related to the peritoneal portion of the shunt have been reported in up to 25% of patients. We present a comprehensive pictorial essay including computed tomography, conventional radiography, ultrasound, and nuclear medicine examples illustrating abdominal complications related to CSF shunting and a review of the current literature. The purpose of this pictorial essay is to provide multimodality imaging examples of CSF shunt complications and familiarize the abdominal imager with the spectrum of findings.