LAUSR

was performed. This demonstrated a large cystic collection in the subhepatic space pushing the diaphragm above and liver below, confirming an abdominal pseudocyst (Fig. 1B). The right lung was collapsed due to pressure from the pseudocyst, so a percutaneous therapeutic drainage of ~400mL of cyst fluid was performed to relieve this pressure. Subsequent biochemical analysis confirmed that the cyst fluid was CSF. There was gradual expansion of the right lung following cyst drainage (Fig. 1C) and the child’s condition stabilized. He then underwent further shunt revision and placement of a ventriculoatrial shunt, and was discharged from hospital on the seventh postoperative day in a stable condition. This case illustrates an unusual complication of VP shunt surgery in a child presenting with respiratory distress. The etiology of the respiratory distress required a thorough investigation to determine its cause, which was not immediately apparent. Similar cases of abdominal pseudocyst have been reported previously, but after 13 and 21 years of VP shunt placement.2,3 Mediastinal lymphangioma and giant thymic cysts have also been reported to mimic pleural effusion.4,5 Unlike mediastinal pathology, our case presented with a large abdominal CSF pseudocyst that mimicked pleural effusion. Moreover, the respiratory sequelae of the pseudocyst occurred earlier than in previous reports, perhaps because it occurred in a child.