PMC4078457_01
Neuroradiological findings on presentation. Brain CT showing enlarged lateral ventricles with slit ventricle (a, b), and abdominal and pelvic CT demonstrating the course of the ventriculo-peritoneal shunt catheter (arrows) and the massive cerebrospinal pseudocyst surrounding the peritoneal end (c, d)
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F1
C-reactive protein level was 31.8 mg/dl. Chest X-ray was negative but brain and abdominal computed tomography (CT) scans revealed enlarge lateral ventricles, a huge peritoneal cyst surrounding the distal end of the peritoneal tube, and fluid in the sheath surrounding the peritoneal tube, indicating possible shunt blockage and a concomitant increase in intracranial pressure (ICP) [Figure 1].
Abdominal and pelvic CT after the first (a) and second (b, c) surgeries. Distal part of the shunt tube inserted for external drainage (yellow arrow) of the pseudocyst. Although the fluid volume decreased, it was not completely cleared (white arrow) (a). CT showing the transcutaneous drainage tube (white arrow) and the recollected cyst fluid (yellow arrow) (b, c)
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F2
In the second stage of treatment, transcutaneous drainage of the cyst under CT guidance was performed; however, again cyst fluid recollected [Figure 2].
CT after insertion of the ventriculo-pleural shunt. Brain CT showing decreased lateral ventricle volume (a, b). Chest CT showing the distal part of the shunt (arrow), a small amount of cerebrospinal fluid in the thorax and the distal tube of the previous CP shunt (arrowhead) (c)
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F3
Thus, the patient was diagnosed with an abdominal pseudocyst associated with TBP and successfully treated by anti-TB agents following insertion of a ventriculo-pleural shunt [Figure 3].