LAUSR

To JNA Readers: Ventriculoperitoneal (VP) shunt is an established procedure for the treatment of hydrocephalus of various causes. This procedure is not free of complications; infection, shunt blockage or tip migration, and cerebrospinal fluid (CSF) over drainage are frequently reported. Abdominal CSF pseudocyst is a relatively uncommon complication of VP shunt (incidence 1% to 4%) that usually presents in the pediatric patients but can occur at any age.1 We report a case of abdominal CSF pseudocyst (secondary to VP shunt surgery) mimicking pleural effusion, which has not previously been reported. Written informed consent was obtained from the child’s parents for publication of this case. A 5-year-old boy with history of VP shunt placement andmultiple revision surgeries for congenital hydrocephalus presented with respiratory distress. His last surgery, revision of the lower end of a right-sided VP shunt, was performed a month earlier. On examination, the patient was conscious, oriented, and afebrile with a respiratory rate of 26 to 28/min and oxygen saturation of 99% on room air. Other vital signs and arterial blood gas parameters were within normal limits. A chest x-ray suggested right sided pleural effusion, but this could not be confirmed because the right diaphragm was not visualized (Fig. 1A). Ultrasonography of the abdomen revealed a large fluid collection with multiple septations in the perihepatic space; the diaphragm could not be located at its usual site. For a definitive diagnosis, an