Abdominal cerebrospinal fluid (CSF) pseudocyst presented with inferior vena caval obstruction and hydronephrosis.
OBJECTIVE
Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon complication of ventriculo-peritoneal shunt placement. A large pseudocyst may exert a significant pressure effect, but vascular or urological symptoms are extremely rare. We report an unusual case of a CSF pseudocyst causing inferior vena caval and ureteric obstruction.


METHODS
A 14-year-old girl had previously undergone ventriculo-peritoneal shunting for congenital hydrocephalus. She developed bilateral ankle edema as the only presenting symptom of a large non-infected cerebrospinal CSF pseudocyst. The associated abdominal distension was initially attributed to obesity, and the patient was unable to communicate due to developmental delay. Imaging studies showed that the pseudocyst was causing inferior vena caval obstruction and bilateral hydronephrosis. The ankle edema and hydronephrosis resolved after aspiration of the pseudocyst and shunt revision.


CONCLUSIONS
Children who require CSF shunting may suffer from associated developmental delay and are frequently unable to communicate their symptomatic complaints. This case illustrated the importance of a heightened clinical suspicion in managing these patients in whom shunt failure may present with subtle and obscure signs of lower body venous congestion.
Leung
Gilberto Ka Kit
GK
Division of Neurosurgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong Special Administrative Region, China. gilberto@hkucc.hku.hk
D000005:Abdomen / Q000601:surgery*; D000293:Adolescent; D003560:Cysts / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D006869:Hydronephrosis / Q000175:diagnosis* / Q000209:etiology; D014684:Venae Cavae / Q000601:surgery*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*