A. Seifarth (Klinikum Augsburg/Abteilung Kinderradiologie/Augsburg/Germany), K.Vollert(Klinikum Augsburg/Abteilung Kinderradiologie/Augsburg/Germany)  

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12 Years  

Male  

Abdomen-Other and unknown  

physical  

History reveals weight gain of 3 kg within the last 2 weeks.
Known lumbosacral meningomyelocele with closure on post delivery day 1.
Arnold-Chiari-Malformation type II.
Known internal hydrocephalus, last revision of the VP shunt 8 years ago.
Under consideration of the known illness no significant neurological findings.
Markedly distended abdomen.
Pretibial edema.
Restriction of deep inspiration.
Diminished breath sounds in the lung bases.  

In a patient with known Arnold Chiari malformation (type II), there is a ventricular shunt with intraperitoneal drainage. Most likely, the large, intraperitoneal liquorcele was forming a while before it caused symptoms (not within 2 weeks, as the mother stated). Interestingly, the cerebral ventricles, even with the large fluid accumulation in the abdominal region, were not enlargened, and actually appeared to be collapsed, which points us to over-drainage.  

Day 1


<- view Ultrasound 1

Ultrasound 1: Abdominal ultrasound: There is an almost the entire abdomen occupying (volume about 3 liters), sharply marginated lesion with peripheral septations. The VP shunt is identified within this space occupying lesion.




<- view Ultrasound 2

Ultrasound 2: Abdominal ultrasound





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X-Ray 1: VP shunt course
In comparison with previous exams unchanged position of the shunt with both ventricular catheters projecting ver the right ventricle. There is elevation of the diaphragm with congestion of the heart and lung. The abdomen is distended. The shunt demonstrates a loop in the abdomen. Known spina bifida in the lumbosacral area.





<- view X-Ray 2

X-Ray 2: VP shunt course





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CT 1: CCT: No dilatation of the ventricles or basal cisternes (anterior horns of the lateral ventricles are collapsed - more in the sense of n overdrainage). There is no bleed, no tumor, no infarct. Known agenesis of the corpus callosum. 2 ventricular drainage catheters from right parietal, with correct position of the catheter tips in the right ventricle.



<- view CT 2

CT 2: CCT




Day 2



<- view MRI 1

MRI 1: MRI of the abdomen: There is a nearly the entire abdomen filling cystic structure. The lesion demonstrates a fluid isointense internal signal with mild marginal contrast enhancement. Within the lesion is theperitoneal part of the VP shunt identified which lies freely within the cyst. The intestines are markedly displaced by the lesion, otherwise unremarkable upper abdominal organs.
Please note the drainage location intraperitoneal as well as extraperitoneal.




<- view MRI 2

MRI 2: MRI of the abdomen

 

Total constellation (Consens)  

Without MRI examination, a mesenterial cyst or a cystic lymphangioma would be possible sonographic differential diagnoses. Due to the combination of the history of the patient and the MRI findings, these differential diagnoses fall by the wayside.  

After imaging, the VP shunt was changed to a VA shunt.  

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Liquorcele, VP-Shunt, VP Shunt, Ventriculoperitoneal shunt, child, childhood, pediatric radiology  

A Seifarth. Intraabdominal Liquorcele in Ventriculoperitoneal Shunt & Arnold Chiari Malformation (Type II). PedRad [serial online] vol 7, no. 4.
URL: www.PedRad.info/?search=20070417083647