Echocardiography in patients with chest x-ray diagnosis of cardiomegaly at an academic hospital in Zambia

Abstract

Cerebrospinal fluid ascites following ventriculo- peritoneal shunting for hydrocephalus is a very rare complication. We present the first case at our hospital. A 3year old female with communicating hydrocephalus presented with massive ascites. It recurred with 2-3weeks of ascitic tap to dryness. Other possible causes of ascites were excluded by normal renal and liver function tests and clinically normal cardiac function. Tests done on the ascitic fluid showed that it was consistent with cerebrospinal fluid with no signs of infection. CT abdomen excluded abdominal masses and CSF pseudo-cyst. A ventriculo-Atrial shunt was done and the ascites slowly regressed over the next 2-3 weeks with no recurrence. The reason why the peritoneum failed to absorb the CSF was not established.

Sterile Cerebrospinal Fluid Ascites With High Serum Ascites Albumin Gradient Treated With Acetazolamide

“…[5][6][7][8] Placement of a Denver shunt has also shown good results. 9 Our case is notable for many reasons: The patient's symptoms presented almost 38 years after the placement of her VP shunt, representing the largest interval reported as of yet. We could theorize her CSF ascites was multifactorial, given the presence of a pseudocyst around her VP shunt, and her response to acetazolamide, indicating CSF overproduction as a culprit.…”

“…3,[5][6][7][8] Its pathophysiology remains a controversial topic, and proposed theories include (i) increased production of CSF surpassing the absorption capacity of the peritoneum, (ii) impaired peritoneal absorption because of high protein quantity in the CSF, and (iii) chronic peritoneal inflammation. 5,9 The formation of pseudocysts has also been reported as a cause of CSF ascites. 10 VP to VA shunt conversion has been successful as treatment.…”

“…This is consistent with previous cases of CSF ascites. 9 The cause of high SAAG in CSF ascites cases could be due to the intrinsically low albumin content of the CSF, as well as the lack of albumin production in the central nervous system. 11 Her β2-transferrin test, a biomarker with 99%–100% specificity for CSF, was initially positive, all but confirming that her accumulated abdominal fluid was CSF.…”