Intrahepatic cerebral spinal fluid pseudocyst: A case report

S. Tawfeeq, Ahmed; R. Al-Sadoon, Emad

	Intrahepatic cerebral spinal fluid pseudocyst: A case report
Medical Journal of Tikrit
Article 1, Volume 2, Issue 142, 2016, Pages 35-37
Authors
Ahmed S. Tawfeeq; Emad R. Al-Sadoon
Abstract
A 5 year old boy presented with shortness of breath, chest pain, and fever for the last few days. He had history of hydrocephalus secondary to aqueduct stenosis diagnosed after birth and ventriculo-peritoneal (V-P) shunt was done for him at age of 6 month. The pregnancy was unremarkable and he delivered by caesarian section at term because of obstructed labor due to large head. The physical examination revealed a toxic child, ill looking, pale, with large head and he was dyspnic with severe chest retraction but no cyanosis. Vital signs: Temperature is 40 C, Respiratory rate is 55 breath / minute, and blood pressure is 75 / 50. Chest examination revealed limitation of movement at the right side of chest, vocal fremitus is diminished, and dullness at right upper and lower chest with diminished air entry at the right side of chest, the trachea was centrally positioned. Auscultation of chest shows diminished breath sounds at right side of chest with fine crackles in both lungs. First and second heart sound were normal. Local examination of the valve of the shunt was poorly functioning with indentation lasting more than 5 minutes.The child was admitted to Tikrit Teaching Hospital (TTH) and send for blood tests, chest X – ray, abdominal ultrasound and CT-scan investigations. The blood investigations was as follow: Hb 10 g/dl ., WBC 15000 / mm³ . Platelets 150000/l. Blood film: hypochromic microcytic anemia with no abnormal cells.Liver function test was normal, BUN & Serum creatinine was normal.Cerebrospinal fluid (CSF) aspiration reveals clear fluid under normal pressure And shows the following results: cells = 0 cell / hpf , protein 15 mg /dl, sugar 66 mg /dl ( blood sugar was 110 mg /dl), and latex agglutination test is normal finding.Chest X-Ray findings & CT-scan findings as following:Chest X-ray PA and lateral views showing homogenous opacity occupying middle and lower zones of right hemithorax ,with suspicious elevation of right hemidiaphragm on lateral view raising the possibility of subphrenic collection or hydatid cyst(fig 1). Abdominal ultrasound exam was done, confirming intrahepatic fluid collection (picture not available), later on CT scan exam of upper abdomen was done with coronal and saggital reformatting, revealing intrahepatic localized fluid collection with end of V-P shunt catheter seen at the periphry.(fig2)
Keywords
Intrahepatic cerebral spinal fluid pseudocyst

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