The sonographic signs of the peritoneal pseudocyst obstructing the ventriculo-peritoneal shunt in children

Grunebaum, Michael F.; Ziv, N.; Kornreich, Liora; Horev, Gadi; Lombrozo, R

doi:10.1007/bf00404109

Cited by 13 publications

(6 citation statements)

References 5 publications

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“…[28] Sonographic signs include a sonolucent mass with/without septations, the so-called railroad sign and a fluid-echo line. [17] More commonly, it can be visualized as a smooth pseudomembrane echo-free fluid collection. [28] CT, while considered as definitive as ultrasound,[11] is more costly, and offers radiation exposure.…”

Section: Discussionmentioning

confidence: 99%

Management of abdominal pseudocyst in shunt-dependent hydrocephalus

Yuh¹,

Vassilyadi²

2012

Surg Neurol Int

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Background:Abdominal pseudocyst (APC) is an uncommon manifestation of a ventriculoperitoneal (VP) shunt that is attributed to an inflammatory response, usually the result of infection.Case Description:A 13-year-old girl with a VP shunt presented with progressive abdominal distention, pain and vomiting. The shunt was inserted at infancy for congenital hydrocephalus. A shunt infection was treated with externalization of the shunt, antibiotics and subsequent shunt replacement. At the age of four, the shunt was revised for a distal malfunction. Nine years later, abdominal CT and ultrasound demonstrated large multiseptated cysts. The shunt was externalized and 1.8 L of sterile, xanthochromic peritoneal fluid was drained. The cerebrospinal fluid was clear, colorless, acellular and sterile with normal protein and glucose levels. Two days later, the distal portion of the shunt was replaced back into the pleural cavity. Five months later a pleural effusion formed. Thoracentesis was performed and there was no evidence of infection. The shunt was subsequently converted to a ventriculoatrial system. The patient has remained well for over 3.5 years.Conclusion:APC represents an important complication of VP shunts, with an unclear etiology that can occur nine years after shunt surgery. This paper presents an update on the management of APCs.

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Section: Discussionmentioning

confidence: 99%

Management of abdominal pseudocyst in shunt-dependent hydrocephalus

Yuh¹,

Vassilyadi²

2012

Surg Neurol Int

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“…It is important to identify the shunt tip within the pseudocyst, and the hyperechoic tip must be differentiated from septa 9 . The shunt tip will produce an echo signal of higher amplitude than a septum, and the two parallel sides of the shunt produce the characteristic ‘railroad sign’ 8 . Visualizing the shunt tip within the cyst also helps distinguish a CSF pseudocyst from pancreatic pseudocyst or ovarian cystadenoma 9 .…”

Section: Discussionmentioning

confidence: 99%

“…7 It has been suggested that smaller pseudocysts tend to be infected, and larger pseudocysts tend to be sterile, 5 Ultrasound shows a well-defined sonolucent mass, with posterior acoustic enhancement. A non-infected cyst will show uniform echotexture within, 8 whereas septa may occur in an infected pseudocyst, which often has internal echoes or a fluid level. 8,9 It is important to identify the shunt tip within the pseudocyst, and the hyperechoic tip must be differentiated from septa.…”

Section: Discussionmentioning

confidence: 99%

“…A non-infected cyst will show uniform echotexture within, 8 whereas septa may occur in an infected pseudocyst, which often has internal echoes or a fluid level. 8,9 It is important to identify the shunt tip within the pseudocyst, and the hyperechoic tip must be differentiated from septa. 9 The shunt tip will produce an echo signal of higher amplitude than a septum, and the two parallel sides of the shunt produce the characteristic 'railroad sign'.…”

Section: Discussionmentioning

confidence: 99%

“…9 The shunt tip will produce an echo signal of higher amplitude than a septum, and the two parallel sides of the shunt produce the characteristic 'railroad sign'. 8 Visualizing the shunt tip within the cyst also helps distinguish a CSF pseudocyst from pancreatic pseudocyst or ovarian cystadenoma. 9 Computed tomography examination shows a cyst containing homogeneous water density fluid.…”

Section: Discussionmentioning

confidence: 99%

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Abdominal cerebrospinal fluid pseudocyst

Pathi

Sage

Slavotinek

et al. 2004

Australasian Radiology

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A case of an abdominal cerebrospinal fluid (CSF) pseudocyst in a patient with a ventriculoperitoneal shunt is reported to illustrate this known but rare complication. In the setting of a VP shunt, the frequency of abdominal CSF pseudocyst formation is approximately 3.2%, often being precipitated by a recent inflammatory or infective process or recent surgery. Larger pseudocysts tend to be sterile, whereas smaller pseudocysts are more often infected. Ultrasound and CT each have characteristic findings.

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Abdominal CSF pseudocysts in patients with ventriculo-peritoneal shunts. Report of fourteen cases and review of the literature

et al. 1994

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The abdominal intraperitoneal cerebrospinal fluid pseudocyst is an infrequent but important complication in patients with ventriculoperitoneal shunts. Since 1954, 115 cases of paediatric pseudocysts have been reported in the literature. One additional report deals with an adult patient. We report on 14 cases of sonographically diagnosed abdominal pseudocysts. Their aetiology, diagnosis, clinical signs and symptoms and surgical management are investigated. In our hydrocephalus series we have an incidence of pseudocyst formation of 4.5%. The most common presentation of the paediatric patients is with symptoms of elevated intracranial pressure and abdominal pain, whereas the adults have predominantly local abdominal signs. Diagnosis is readily made with ultrasonography. Predisposing factors for pseudocyst formation are multiple shunt revisions and infection. Microscopically, the pseudocysts consist of fibrous tissue without epithelial lining. The treatment involves surgical removal of the catheter with or without excision of the pseudocyst wall and placement of a new catheter intraperitoneally in a different quadrant or an intra-atrial shunt. Recurrences are rare, especially under appropriate medical treatment of infection. In our series, microbiologically proven infection was present in 30% of the cases.

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The sonographic signs of the peritoneal pseudocyst obstructing the ventriculo-peritoneal shunt in children

Cited by 13 publications

References 5 publications

Management of abdominal pseudocyst in shunt-dependent hydrocephalus

Management of abdominal pseudocyst in shunt-dependent hydrocephalus

Abdominal cerebrospinal fluid pseudocyst

Abdominal CSF pseudocysts in patients with ventriculo-peritoneal shunts. Report of fourteen cases and review of the literature

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