RESIDENT
& FELLOW
SECTION
Section Editor
Mitchell S.V. Elkind,
MD, MS
Jeffrey Forris Beecham
Chick, MD
Nikunj Rashmikant
Chauhan, MD
Katherine Marie Mullen,
MD
Nirav Vikram Kamdar,
MD
Bharti Khurana, MD
Correspondence to
Dr. Chick:
jchick@partners.org
Teaching NeuroImages:
Massive abdominal CSFoma
A 31-year-old woman with congenital hydrocephalus
status post ventriculoperitoneal shunt placement 23 years
earlier presented with abdominal distention. The patient
denied fever, headache, or sensory or motor abnormali-
ties. Examination was notable for a tense abdomen.
CT of the abdomen and pelvis demonstrated a massive,
loculated, CSFoma, or CSF pseudocyst (figure). Ventri-
culoperitoneal shunts are associated with a variety of
complications including disruption of the tube, obstruc-
tion of the tip, infection, intestinal perforation, tip migra-
tion, and CSFoma development.1 CSFoma is a rare
complication, thought to be caused by low-grade shunt
infection, chronic inflammation, increased CSF protein,
or peritoneal adhesions, and is estimated to occur in
1.0% to 4.5% of cases, with a typical occurrence within
3 weeks to 5 years of shunt placement.2,3 Treatment
consists of external drainage or surgical excision followed
by reconstruction of the shunt system.4
AUTHOR CONTRIBUTIONS
All authors contributed equally to the creation of the text, preparation of
the images, and revision of the manuscript.
STUDY FUNDING
No targeted funding reported.
DISCLOSURE
The authors report no disclosures relevant to the manuscript. Go to
Neurology.org for full disclosures.
REFERENCES
1. Besson R, Hladky JP, Dhellemmes P, Debeugny P. Perito-
neal pseudocyst: ventriculo-peritoneal shunt complications.
Eur J Pediatr Surg 1995;5:195–197.
2. Rainov N, Schobess A, Heidecke V, Burkert W. Abdominal
CSF pseudocyst in patients with ventriculo-peritoneal shunts:
report of fourteen cases and review of the literature. Acta
Neurochir 1994;127:73–78.
3. Coley BD, Shiels WE, Elton S, Murakami JW, Hogan MJ.
Sonographically guided aspiration of cerebrospinal fluid pseu-
docysts in children and adolescents. AJR Am J Roentgenol
2004;183:1507–1510.
4. Hahn YS, Engelhard M, McLone DG. Abdominal CSF
pseudocyst: clinical features and surgical management.
Pediatr Neurosci 1985–1986;12:75–79.
Figure Imaging
(A) Coronal and (B) sagittal images from CT of the abdomen and pelvis with IV contrast material demonstrating the course
of a ventriculoperitoneal shunt catheter with a massive, 25 3 24 3 12 cm, loculated, CSFoma, or CSF pseudocyst,
surrounding the ventriculoperitoneal shunt catheter (arrowheads).
From the Department of Radiology (J.F.B.C., N.R.C., K.M.M., B.K.), Brigham and Women’s Hospital, Harvard Medical School; and Department
of Anesthesia, Critical Care and Pain Medicine (N.V.K.), Massachusetts General Hospital, Harvard Medical School, Boston, MA.
e146 © 2013 American Academy of Neurology
ª 2013 American Academy of Neurology. Unauthorized reproduction of this article is prohibited.
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