Peritoneal CSF Pseudocyst Demonstrated on Scintigraphy With Tc-99m DTPA: A Case Report and Literature Review

核醫腦室－腹膜分流暢通性檢查意外發現一個於成人罕見的腹膜腦脊液假性囊腫：病例報告和文獻綜述

蕭宇儁(Yu-Chun Hsiao) ； 張添信(Tien-Hsin Chang) ； 羅中平(Chung-Ping Lo) ； 陳慶元(Ching-Yuan Chen)

《核子醫學暨分子影像雜誌》 34卷3期 (2021/09) Pp. 133-138

https://doi.org/10.6332/ANMMI.202109_34(3).0003

摘要

Peritoneal cerebrospinal fluid (CSF) pseudocyst is a complication of a ventriculoperitoneal shunt (VPS), which rarely occurs in adults, so such case reports are rare. We report here that the recurrence of hydrocephalus in an adult patient was caused by a rare peritoneal CSF pseudocyst, which was confirmed by subsequent scintigraphy and computed tomography (CT). A 60-year-old woman presented with clinically progressive weakness of the lower limbs, unable to walk, silence and slow speech, bilateral hearing impairment, and urinary incontinence, but no headache, diplopia, nausea, and vomiting. The results of brain CT showed hydrocephalus. Therefore, she underwent surgery to insert the VPS, and then she recovered as usual. One month later, she underwent a brain CT follow-up examination, which showed that the ventricles had shrunk. About 8 months after the shunt procedure, her previous symptoms reappeared. In the beginning, she also had fever, nausea, and vomiting. During the physical examination, only the muscle power of the limbs decreased (grade 3), and other neurological examinations were normal. The abdomen was oval in shape, without focal tenderness. When she was in the emergency room, her fever had subsided. The test results of blood and CSF were within the normal range. Subsequent CT of the brain confirmed the recurrence of hydrocephalus, so she was referred to the Department of Nuclear Medicine for VPS examination. A rare peritoneal CSF pseudocyst was accidentally discovered, which was confirmed by abdominal CT. After the patient received a new replacement of the VPS, the symptoms disappeared and the original function was restored.

關鍵字

peritoneal cerebrospinal fluid (CSF) pseudocyst ； scintigraphy with Tc-99m DTPA ； ventriculoperitoneal shunt (VPS)

並列摘要

腹膜腦脊液假性囊腫是一種腦室－腹膜分流術的併發症，罕見發生於成人，故此類病例報告很少。我們在此報告了一位成年患者的腦積水復發的病例，是由一個罕見的腹膜腦脊液假性囊腫所造成，並在隨後的核醫及電腦斷層檢查獲得證實。一名60歲的女性，臨床上出現下肢進行性無力，無法行走，沉默和言語緩慢，雙側聽力障礙和尿失禁，但沒有頭痛，複視，噁心和嘔吐。腦部電腦斷層檢查結果發現有腦積水。於是她接受了腦室－腹膜分流管置入手術，術後她恢復如往常一般。於1個月後，她接受腦部電腦斷層追蹤檢查，顯示腦室縮小。約在分流管置入手術8個月後，她先前的症狀再度出現，一開始她還合併有發燒，噁心和嘔吐。理學檢查時，只有四肢的肌肉力量下降（3級），其他神經系統檢查是正常的。腹部呈卵圓形，無局部壓痛。當她在急診室時，發燒已消退。血液與腦脊髓液的檢查結果皆在正常範圍內。隨後的腦部電腦斷層檢查證實了腦積水復發，於是她被轉介到核醫學科接受腦室－腹膜分流暢通性檢查，意外發現一個罕見的腹膜腦脊液假性囊腫，並在腹部電腦斷層檢查後獲得證實。隨後病患接受腦脊液分流管重新置換後症狀消失，並恢復了原本功能。

並列關鍵字

腹膜腦脊液假性囊腫 ； 腦室－腹膜分流併發症 ； 核醫腦室－腹膜分流暢通性檢查