Answer for CoW 05 Feb 2017
PERITONEAL CSF PSEUDOCYST WITH PERTONEAL INCLUSION CYST.
Findings
Given sequences are T2 haste axial and coronal , vibe dixon axial and coronal 21× 18 cm well defined collection without any septations noted in the peritoneal cavity extending from subdisphragmatic region to pelvic brim. VP shunt tube noted traversing through the collection. Bilateral ovaries are separately visualised and appears normal. Another well defined cystic lesion with internal septations noted in pelvis encasing bilateral ovaries and extending into pouch of Douglas.
Discussion
Peritoneal csf pseudocysts are rare complication of ventriculoperitoneal shunt catheter placement. The wall is composed of fibrous tissue without an epithelial lining and is filled with cerebrospinal fluid. Debris is identified in the majority of the fluid collections. Cerebrospinal fluid pseudocysts are seen as a thin-walled cystic mass around the shunt tip. Ultrasonography or CT can indicate the definitive diagnosis. multiple septae may form chronically. debris and internal echoes are seen if the mass is infected Peritoneal inclusion cyst (PIC) (also known as a peritoneal pseudocyst) is a type of cyst-like structure that appears in relation to the peritoneum and results from a non neoplastic reactive mesothelial proliferation. Assocations previous abdominal trauma previous pelvic inflammatory disease previous abdominal surgery endometriosis They are usually caused by accumulation of ovarian fluid that is contained by a peritoneal adhesion. The development of a peritoneal inclusion cyst depends on the presence of an active ovary and peritoneal adhesions. Pelvic MRI The location of the ovary with respect to the cysts is clearly demonstrated on MRI. They tend to appear as irregular cystic masses. Signal characteristics are: T1: hypointense T2: hyperintense T1 C+ (Gd): no enhancement of cyst wall. lack of a discrete limiting wall no mural nodularity minimal internal debris
Findings
Given sequences are T2 haste axial and coronal , vibe dixon axial and coronal 21× 18 cm well defined collection without any septations noted in the peritoneal cavity extending from subdisphragmatic region to pelvic brim. VP shunt tube noted traversing through the collection. Bilateral ovaries are separately visualised and appears normal. Another well defined cystic lesion with internal septations noted in pelvis encasing bilateral ovaries and extending into pouch of Douglas.
Discussion
Peritoneal csf pseudocysts are rare complication of ventriculoperitoneal shunt catheter placement. The wall is composed of fibrous tissue without an epithelial lining and is filled with cerebrospinal fluid. Debris is identified in the majority of the fluid collections. Cerebrospinal fluid pseudocysts are seen as a thin-walled cystic mass around the shunt tip. Ultrasonography or CT can indicate the definitive diagnosis. multiple septae may form chronically. debris and internal echoes are seen if the mass is infected Peritoneal inclusion cyst (PIC) (also known as a peritoneal pseudocyst) is a type of cyst-like structure that appears in relation to the peritoneum and results from a non neoplastic reactive mesothelial proliferation. Assocations previous abdominal trauma previous pelvic inflammatory disease previous abdominal surgery endometriosis They are usually caused by accumulation of ovarian fluid that is contained by a peritoneal adhesion. The development of a peritoneal inclusion cyst depends on the presence of an active ovary and peritoneal adhesions. Pelvic MRI The location of the ovary with respect to the cysts is clearly demonstrated on MRI. They tend to appear as irregular cystic masses. Signal characteristics are: T1: hypointense T2: hyperintense T1 C+ (Gd): no enhancement of cyst wall. lack of a discrete limiting wall no mural nodularity minimal internal debris
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!