intraabdominelle Liquorzele bei VP-Shunt

Ventriculoperitoneal
shunt complications: a local study at Qena University Hospital: a retrospective study. a CT abdomen axial view of a 13-year-old male patient showing right hypochondrial cyst (a arrow). b Abdominal ultrasonography done for the same patient, and right hypochondrial cyst was found (b arrow). c Ultrasonic-guided aspiration was done from this cyst, and the aspirate was clear CSF
EJNS.springeropen.com • CC-by-4.0
Hemorrhagic
abdominal pseudocyst following ventriculoperitoneal shunt: a case report. a Abdominal CT demonstrated a large cyst comprising a collection of homogeneous iso-density fluid in the abdominal cavity with displacement of the bowel loops to the posterior part. b The distal segment of the ventriculoperitoneal shunt catheter was located within the cystic mass with clear margins. The cyst and the shunt catheter were indicated by white arrows
bmcsurg.biomedcentral.com • CC-by-4.0
Liver
abscesses associated with ventriculoperitoneal shunt infection: A rare complication. Axial venous phase image shows VP shunt within collections in segment VI of liver.
www.eurorad.org • CC by-nc-sa-4.0
Liver
abscesses associated with ventriculoperitoneal shunt infection: A rare complication. Coronal portovenous CECT image shows a collection indenting segment V of liver with shunt in situ. Shunt is also seen within the peritoneal cavity.
www.eurorad.org • CC by-nc-sa-4.0
Infant with
increasing abdominal distension over 4 daysAxial CT with intravenous and oral contrast of the abdomen shows an extremely large mass filling the abdomen with the tip of the VP shunt within it which is causing hydronephrosis and displacement of the bowel.The diagnosis was VP shunt malfunction due to a CSFoma.
pediatricimaging.org • CC-by-nc-sa 4.0
Preschooler
with 2 weeks of abdominal distensionAP and lateral radiographs of the abdomen show the VP shunt to be coiled upon itself and there is a suggestion of a retrogastric mass on the lateral view. Transverse US of the left upper quadrant of the abdomen shows a large cystic structure with the VP shunt tip within it.The diagnosis was VP shunt malfunction due to CSFoma.
pediatricimaging.org • CC-by-nc-sa 4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

A peritoneal CSF pseudocyst is a rare complication of ventriculoperitoneal shunt catheter placement. The time from the last shunting procedure to the development of an abdominal pseudocyst ranges from 3 weeks to 5 years.

Pathology

The wall is composed of fibrous tissue without an epithelial lining and is filled with CSF (cerebrospinal fluid). Debris is identified in the majority of the fluid collections.

The pseudocyst can either move freely within the peritoneal cavity or adhere to small-bowel loops, the serosal surface of solid organs, the parietal peritoneum, or small-bowel loops. The latter would explain why some bowel loops may become engulfed when the pseudocyst increases in size or why the pseudocyst may be prone to torsion.

Pediatric patients commonly present with symptoms of elevated intracranial pressure and abdominal pain, whereas adults predominantly present with abdominal signs only.

Radiographic features

Cerebrospinal fluid pseudocysts are seen as a thin-walled cystic mass around the shunt tip. Ultrasonography or CT can indicate the definitive diagnosis.

Ultrasound

This is the method of choice in the evaluation of the pseudocyst and other complications at the distal end of the ventriculoperitoneal shunt.

  • well defined hypoechoic / anechoic cystic mass with tip of VP shunt within it 
  • pressure effects on adjacent organs if mass is huge 
  • multiple septa may form chronically
  • debris and internal echoes are seen if the mass is infected 
CT

May show a small or massive, loculated cyst-like structure in the peritoneal cavity at the distal tip of VP shunt.

Measurement of attenuation values with CT characterizes the contents as water attenuation and demonstrates the relationships of portions of the shunt catheter with the pseudocyst.

Treatment and prognosis

Excision or repositioning of the shunt tip with minimally invasive laparoscopic techniques is usually performed. This technique in the setting of a non-infected pseudocyst has proved to be safe, with results comparable to those of a conventional open surgical technique.

If infection is present, the pseudocyst wall should be excised and the peritoneal shunt tube removed. Percutaneous drainage of the pseudocyst can be both diagnostic and therapeutic.

Differential diagnosis

Possible differential considerations include

It may be difficult to differentiate seroma, urinoma, abscess, lymphocele, and cerebrospinal fluid on the basis of imaging findings alone. Fine-needle aspiration with ultrasound or CT guidance has a high diagnostic yield.

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu intraabdominelle Liquorzele bei VP-Shunt:
Pankreaspseudozyste
 
Wikipedia • CC BY-SA 4.0
ventrikuloperitonealer
Shunt
Wikipedia • CC BY 3.0
Dysfunktion
ventrikuloperitonealer Shunt
pediatricimaging.org • CC-by-nc-sa 4.0