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CSF PSEUDOCYST
Authored By: Delphine Chen and O'Neil Lee.
Patient: 23 year old male
History: 23 year old male with cerebral palsy and increasing headache.
Image Size:[small][as-submitted]

Fig. 1

Fig. 2
90 minutes post-injection

Fig. 3
2 months prior

Fig. 4
Current

Fig. 5
CT correlation
Image Size:[small][as-submitted]

Findings: 1. CSF shunt study demonstrates increasing focal accumulation of tracer at the inferior tip of the ventriculoperitoneal (VP) shunt.  Free flow of tracer is not observed within the peritoneum. 

2. Abdominal radiographs show coiling at the inferior tip of the VP shunt.  Additionally, the position of the VP shunt catheter has not changed in 2 months.

3. CT images show a loculated fluid collection in the abdomen with coiling of the VP catheter within this fluid collection.
DDx: CSF pseudocyst.
Diagnosis: CSF pseudocyst.
General Discussion: The CSF shunt study should demonstrate normal cradiocaudal flow of the tracer in the catheter and free flow of the tracer diffusely throughout the peritoneum.  In this case, there was a focal accumulation of the tracer at the inferior tip of the VP shunt catheter, indicating an obstruction at the tip of the catheter.  Free flow of the tracer throughout the peritoneum was not seen on delayed images.

Corresponding abdominal radiographs and CT scan images confirm the suspicion of a loculated CSF collection.

The patient was taken to the operating room, and a CSF pseudocyst was diagnosed.  The patient's VP shunt was externalized, and his symptoms improved.
References: Mettler, Fred A., and Milton J. Guiberteau. Essentials of Nuclear Medicine Imaging. Philadelphia: Saunders, 2006.
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Additional Details:

Case Number: 123466Owner(s): Delphine Chen and O'Neil LeeLast Updated: 02-07-2013
Anatomy: Other   Pathology: Other
Access Level: Readable by all users, writable by NucMed Certifiers
ACR: 70000.31000

Case has been viewed 28 times.
Certified by Delphine Chen on 01-30-2009

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