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296

D.T. Ginat et al.

 

 

6.2.12\ Peritoneal Pseudocysts

Pseudocysts are variable in size and appear-

 

ance. Small, loculated collections tend to be

6.2.12.1\ Discussion

infected, while large cysts may be sterile cere-

Intraperitoneal pseudocysts associated with

brospinal fluid collections, although infection

shunt catheters are localized, walled-off col-

with a pseudocyst should be considered regard-

lections of cerebrospinal fluid within the peri-

less of size. Large intraperitoneal pseudocysts

toneal cavity, which is often readily depicted

may cause bowel obstruction, ventriculomeg-

on CT or ultrasound (Fig. 6.49). Nuclear medi-

aly, and increased intracranial pressure, inde-

cine or other shunt studies confirm a communi-

pendent of infectious complications.

cation between the catheter and pseudocyst.

 

a

b

Fig. 6.49  Peritoneal pseudocyst. Axial CT image (a) shows a large, well-defined fluid collection that contains the distal portion of the shunt catheter. Ultrasound image

in a different patient (b) shows an intra-abdominal fluid collection surrounding the shunt catheter (arrow)

6  Imaging of Cerebrospinal Fluid Shunts, Drains, and Diversion Techniques

297

 

 

6.2.13\ Cerebrospinal Fluid Leak

Syndrome

6.2.13.1\ Discussion

Cerebrospinal fluid leakage is an uncommon complication of cerebrospinal fluid shunting procedures. Patients characteristically present with

a

signs of postural cerebrospinal fluid hypotension. On imaging, fluid collections with cerebrospinal fluid characteristics can be found in the soft tissues­ adjacent to the catheter, essentially anywhere along the course of the catheter (Fig. 6.50). There can be associated catheter disconnection or dislodgement.

b

Fig. 6.50  Shunt device associated cerebrospinal fluid leakage. Axial CT image (a) shows a cerebrospinal fluid attenuation collection (arrow) surrounding the reservoir in the left upper neck. Axial CT image in a different

patient (b) shows the distal end of the VP shunt has migrated and coiled within the right anterior abdominal wall subcutaneous tissues, resulting in accumulation of cerebrospinal fluid (arrow)