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Shunt trouble or something else? Diagnosing an abdominal CSF pseudocyst in a child using point-of-care ultrasound
David J McCreary1, Navvya Girdhar2
1Paediatric Emergency Department, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Kayll Road, Sunderland, SR4 7TP, UK. David.mccreary2@nhs.net.
Insights
Point of care ultrasound (POCUS) is a reliable tool for diagnosing abdominal cerebrospinal fluid (CSF) pseudocysts in children with ventriculoperitoneal shunts, differentiating them from other abdominal issues.
Area of Science:
- Pediatric Emergency Medicine
- Medical Imaging
- Neurosurgery
Background:
- Ventriculoperitoneal shunts are increasingly common in preterm infants, necessitating familiarity with potential complications.
- Abdominal cerebrospinal fluid (CSF) pseudocysts are a rare but significant cause of distal shunt failure in children.
- Traditional imaging modalities are being supplemented by point-of-care ultrasound (POCUS) for diagnosis.
Purpose of the Study:
- To evaluate the utility of POCUS in diagnosing abdominal CSF pseudocysts in a pediatric patient with a ventriculoperitoneal shunt.
- To demonstrate POCUS's ability to differentiate CSF pseudocysts from other abdominal pathologies.
Main Methods:
- A case presentation of a 7-year-old girl with a history of prematurity and ventriculoperitoneal shunt insertion.
- Point-of-care ultrasound (POCUS) was used to investigate abdominal distension.
- POCUS identified a large anechoic fluid collection containing the shunt tip, consistent with a CSF pseudocyst, and confirmed gastrostomy tube placement.
Main Results:
- POCUS accurately identified an abdominal CSF pseudocyst in the patient.
- The imaging modality also confirmed the correct positioning of the gastrostomy tube.
- This helped exclude gastrostomy malposition as a differential diagnosis for abdominal distension.
Conclusions:
- POCUS is effective in diagnosing abdominal CSF pseudocysts in patients with ventriculoperitoneal shunts.
- It can differentiate pseudocysts from other causes of abdominal distension, including gastrostomy complications.
- POCUS serves as a safe and reliable first-line imaging tool for these pediatric patients.
Background:
With increasing rates of survival amongst pre-term infants, patients with ventriculoperitoneal shunts are an increasingly common presentation to the emergency department, meaning that paediatricians must be familiar with the potential complications shunts can bring. Abdominal cerebrospinal fluid pseudocyst is a rare complication of ventriculoperitoneal shunts but remains an important cause of distal site failure in children. Irradiating imaging modalities have been traditionally relied upon in the past to help make such diagnoses, however, point of care ultrasound offers many advantages to this and presents itself as a reliable alternative.
Case Presentation:
A 7-year-old girl who was born prematurely at 27 + 6 weeks and had a ventriculoperitoneal shunt inserted as an infant was brought to the Paediatric Emergency Department by her grandparents after they noticed her abdomen was distended. Her grandfather stated that he had replaced her gastrostomy recently and had unable to obtain aspirates for the past 48 h. POCUS revealed a large anechoic fluid collection with the shunt tip visible within it consistent with a CSF pseudocyst. POCUS was also able to confirm position of the gastrostomy balloon in the expected location helping to exclude malposition as a potential differential diagnosis.
Conclusions:
In patients with ventriculoperitoneal shunts, POCUS can correctly identify the presence of abdominal CSF pseudocyst differentiating it from other causes of abdominal distension including gastrostomy-related complications. This case supports the role of POCUS as a safe, reliable first-line imaging tool for diagnosing CSF pseudocysts in patients with ventriculoperitoneal shunts, particularly where previous similar complications have existed.
