Breast Cerebrospinal Fluid Pseudocyst

Iyer, Hridaya P; Jacob, Leon P; Chaudhry, Nadeem

doi:10.1097/01.prs.0000232394.53652.31

Cited by 20 publications

(24 citation statements)

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“…3,11,15 Peritoneal catheter migration has also been described ending into the pulmonary vein and cardiac chambers, chest cavity, and around augmented breast implants. 4,5,13,15 This case report illustrates 2 unusual complications of CSF shunting occurring in the same patient. To our knowledge this is the first presentation of a proximal migration associated with a lactiferous duct injury and CSF galactorrhea.…”

Section: Discussionmentioning

confidence: 99%

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Proximal subcutaneous migration of the distal end of a ventriculoperitoneal shunt presenting with recurrent cerebrospinal fluid galactorrhea

Maknojia

Caron²

2014

JNS

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V entriculoperitoneal shunt insertion is a wellestablished technique for permanent CSF diversion to treat a variety of intracranial pathological conditions most often resulting in hydrocephalus, but it is also used to treat other disorders causing intractable intracranial hypertension. Usually, the distal catheter is inserted by performing a small laparotomy in the right paraumbilical, right subcostal, or median supraumbilical region. Despite advances in shunt technology and implant materials, a myriad of various complications continue to be reported, some most unusual.2 It is estimated that within 1 year of shunt placement 25%-40% of patients experience shunt complications. The risk reduces to 4%-5% annually thereafter. The mean survival of a shunt is approximately 5 years. 16 We present a case of CSF galactorrhea as the sole presenting symptom of a delayed proximal subcutaneous migration of the intraabdominal portion of a VP shunt. Case ReportHistory and Examination. A 46-year-old woman presented with a 6-year history of headaches and progressive visual loss diagnosed as idiopathic intracranial hypertension. All imaging failed to reveal a cause. The only observed risk factor was moderate obesity; the patient had a BMI of 31 kg/m 2 . After medical therapy failed and a left optic nerve sheath fenestration was unsuccessful, she was referred for CSF shunting as definitive treatment. She was scheduled for a VP shunt.Operation. An image-guided right frontal approach was chosen and the peritoneal cavity was entered via a standard right subcostal minilaparotomy by using a muscle-splitting technique through the rectus abdominus. The peritoneum was closed with a purse-string suture after a 90-cm peritoneal catheter connected to a PS Medical Strata II programmable valve (Medtronic, Inc.) was passed freely into the peritoneal cavity. The procedure was without complication and the patient's postoperative imaging revealed intraabdominal placement of the catheter.Postoperative Course. Six weeks after the shunt was implanted, the patient presented with painless, spontaneous clear fluid leakage from her right nipple; on compression it originated from a single duct in a jetlike fashion (Fig. 1). There was no palpable subcutaneous fluid collection along the course of the shunt catheter, and both breasts appeared symmetrical without deformity or sign of injury. She denied any recurrence of her previous symptoms to suggest a shunt malfunction. A sonogram was diagnostic for a subcutaneous fluid collection starting at the abdominal incision and extending to the inferior medial quadrant of the breast. A shunt series demonstrated the path of the distal catheter medial to the breast shadow and complete proximal migration of the peritoneal catheter into the subcutaneous tissues just at the level of the abdominal incision (Fig. 2).This migration was treated by repositioning of the distal end of the migrated catheter into the peritoneal cavity. In addition to a new peritoneal entry site, a subfascial tunnel under the anterior rectus sheat...

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Section: Discussionmentioning

confidence: 99%

“…With the exception of previously reconstructed breasts with the inherent scarring onto the chest wall, an injury to the lactiferous system is very unusual. 5 The rarity of the injury is implied by the absence of reported symptoms and signs such as pain, swelling, hematoma, or bloody discharge.…”

Section: Discussionmentioning

confidence: 99%

Proximal subcutaneous migration of the distal end of a ventriculoperitoneal shunt presenting with recurrent cerebrospinal fluid galactorrhea

Maknojia

Caron²

2014

JNS

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“…The patient had full recovery and was discharged home in the day after surgery. Iyer et al, reported a case of a woman with a 4 month history of ventriculoperitoneal shunt for hydrocephalus who was submitted to an elective breast augmentation after neurosurgery evaluation 12 . Ten weeks later, the patient came to the emergency with light-headness and right breast pain and swelling of 5 days' duration.…”

Section: Discussionmentioning

confidence: 99%

Distal migration of ventriculoperitoneal shunting catheter under silicon breast implant

Mudo

Amantéa

Joaquim

et al. 2009

Arq. Neuro-Psiquiatr.

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“…This may occur with distal shunt obstruction and intraabdominal pseudocyst formation, or fracture of the shunt. 2,6 The CSF may dissect and track around the shunt from the abdomen and present with a subcutaneous mass, due to progressive fluid accumulation. Most of these patients pre sent with signs and symptoms of shunt malfunction and/ or abdominal distension.…”

Section: Discussionmentioning

confidence: 99%

Solid noninfectious growing masses over cerebrospinal fluid shunts: report of 3 cases

James

Postlethwait

Sandler

2015

PED

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The authors describe 3 children who presented with progressively enlarging skin-covered solid masses over the shunt catheter in the neck/clavicular region. The authors reviewed the clinical, laboratory, pathological, radiographic, and follow-up data for all 3 patients and reviewed the literature on the subject. The patients had no clinical evidence of an infectious process. Surgical exploration revealed that masses were surrounding and encasing the shunt tubing to which they were strongly attached. Pathological studies of the tissues demonstrated varying degrees of exuberant chronically inflamed granulation tissues, interstitial fibrosis, and dystrophic calcification. One patient had associated thinning of the skin overlying the mass and subsequently developed ulceration. No infectious organisms were observed. The cerebrospinal fluid aspirates from the shunts did not yield any organisms. There has been no recurrence of the masses. The presence of a growing mass over the shunt tube in the neck or the chest region without clinical evidence of infection does not indicate that the mass should be treated with antibiotics and complete shunt removal. Rather, the mass can be cured by extirpation and with “bypass” new shunt tubing locally.

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Breast Cerebrospinal Fluid Pseudocyst

Cited by 20 publications

References 0 publications

Proximal subcutaneous migration of the distal end of a ventriculoperitoneal shunt presenting with recurrent cerebrospinal fluid galactorrhea

Proximal subcutaneous migration of the distal end of a ventriculoperitoneal shunt presenting with recurrent cerebrospinal fluid galactorrhea

Distal migration of ventriculoperitoneal shunting catheter under silicon breast implant

Solid noninfectious growing masses over cerebrospinal fluid shunts: report of 3 cases

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