Hepatic cerebrospinal fluid pseudocyst: A case report and review of the literature

Abstract

An abdominal pseudocyst is a rare, but important complication in patients with a ventriculo-peritoneal (VP) shunt insertion. Several predisposing factors for this complication have been suggested, including infection, obstruction or dislodgement, but the pathophysiology is still unknown. However, the abdominal inflammatory process is accepted widely as a hypothesis for the formation of an abdominal pseudocyst. In this study, we report the case of a 21-year-old male that presented with a high-grade fever, poor appetite, shortness of breath and unconsciousness 1 week after receiving a VP shunt insertion for obstructive hydrocephalus. Ultrasonography and computed tomographic scans of the abdomen revealed a well-defined large hepatic cyst surrounding the peritoneal tube of the VP shunt. A hepatic cerebrospinal fluid (CSF) cyst was diagnosed and Staphylococcus epidermis was cultured via CSF. After externalization of the VP shunt and adequate antibiotic treatment, the hepatic cyst was resolved. There was no recurrence observed in the regular follow up.

Hepatic cerebrospinal fluid pseudocyst: A rare complication of ventriculoperitoneal shunt

“…[6] The most important factor causing hepatic CSF pseudocyst is the migration of the peritoneal tip of the shunt to the liver surface, causing the focal injury to the liver and its chronic irritation. [14] A review of the cases presented in the literature reveals that prior shunt revision was found only in 45% of the cases. Six hepatic CSF pseudocyst patients (55%) did not report history of shunt revision, and four patients did not describe this information.…”

“…[28] However, in 16 cases of patients with hepatic CSF pseudocyst published in the literature, including our case, only three cases (19%) were reported to have CNS infection on presentation, two cases with CSF culture demonstrated S. epidermidis , and one case demonstrated S. aureus -all cases involved adult patients. [1418] For this condition, the data suggest that the incidence of infection in hepatic CSF pseudocyst is lower in children than in adults. Otherwise, the abdominal CSF pseudocyst incidence of infection is greater in children than in adults.…”

“…Several patients with this condition, as in our case, show markedly elevated levels of glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and alkaline phosphatase. [142733] These abnormal findings suggested the presence of an anicteric cholestasis along with hepatic cell necrosis.…”

“…Even more uncommon are pseudocysts of parenchymal organs such as the liver. [2457814151718192527323334] or spleen. [21]…”

Hepatic Pseudocyst as a Result of Ventriculoperitoneal Shunts: Case Report and Review of the Literature

“…Furthermore, protein levels in CSF are high in cases that have tumor and/or shunt infection. The most important factors causing hepatic pseudocyst are migration of the peritoneal tip of the shunt to the liver surface and its chronic irritation [7]. Consequently, the oncotic pressure of the cystic fluid increases, interstitial fluid passes into the cyst, and the cyst increases in size.…”