An Unusual Case of Cerebrospinal Fluid Pseudocyst in a Previously Augmented Breast

Abstract

Cerebrospinal fluid (CSF) drainage catheters can cause a myriad of complications, in large part because they may migrate from their normal location to almost anywhere in the body. We present the unique case of a female patient who had previously undergone bilateral breast augmentation who experienced sudden painless swelling of her right breast 6 weeks after placement of a ventriculoperitoneal shunt. Radiologic examination demonstrated ensnarement of the distal aspect of the shunt around her implant, with subsequent formation of a CSF pseudocyst. Management of this patient included replacement of the shunt, drainage of the CSF pseudocyst, and preservation of the implant.

Distal migration of ventriculoperitoneal shunting catheter under silicon breast implant

“…However, distal catheter migration under a mammary implant is rare. We found just two similar reports; Spector et al, reported a patient with pain and swelling in her right breast 6 weeks after a ventriculoperitoneal shunt to treat hydrocephalus due to a acoustic schwannoma neuroma 11 . At the time of shunt placement, the neurosurgeon was not aware that the patient has been undergone a bilateral breast augmentation some years before.…”

A ventriculoperitoneal shunt catheter wrapped around a right mammary prosthesis forming a pseudocyst

“…[2][3][4] Some patients have developed CSF galactorrhea if the lactiferous duct is injured during subcutaneous tunneling, in addition to the formation of an intra-abdominal CSF pseudocyst. [5][6][7] Between 2005 and 2008 Iyer et al, 8 Spector et al, 9,10 and Torres et al, 11 have each reported a patient with a breast CSF pseudocyst Table 1). Spector et al first reported a patient who had breast augmentation several years prior to shunting and, as for our patient, the neurosurgeon was not aware of her augmentation history.…”

“…Spector et al first reported a patient who had breast augmentation several years prior to shunting and, as for our patient, the neurosurgeon was not aware of her augmentation history. 9 The neurosurgeon thought that migration may have occurred as a result of the patient having lifted heavy items and that traction on the catheter occured from scarring between the pectoralis major muscle and capsular tissue along the shunt tunnel. In contrast, the patient described by Iyer et al underwent augmentation 4 months after shunting.…”

“…Only three other case reports have discussed a shunt migrating around a breast prosthesis, causing an enlarging breast lump. [8][9][10][11] No definite mechanism of shunt migration was determined in these reports. Over 2 months follow-up we observed on a chest X-ray that our patient's peritoneal shunt had gradually migrated around her mammary prosthesis, forming a lump.…”

An unusual cause of breast lump: CSF pseudocyst

“…A few cases of a VP shunt wrapped around a breast prosthesis with subsequent CSF pseudocyst formation have also been reported. 16 Spector et al 9 believed that migration of the VP shunt in their patient was related to lifting heavy weights, compounded by adhesions between the pectoralis major muscle and capsular tissues along the shunt tunnel, which caused significant traction force on the VP shunt. However, in our patient, there was no migration of the VP shunt tip, which remained in the abdominal cavity, and the CSF pseudocyst formation was probably due to inadequate CSF drainage, as evidenced by abdominal pseudocysts and hydrocephalus, following a micro-fracture of the VP shunt in the region of the breast, and subsequent slow seepage of CSF.…”