Malignant ascites after subduroperitoneal shunt in a patient with leptomeningeal metastasis

Abstract

Leptomeningeal metastasis is a devastating complication of advanced stage cancer. It is frequently accompanied by hydrocephalus and intracranial hypertension that must be treated by ventriculoperitoneal shunts. However, there are actual risks of peritoneal seeding or accumulation of malignant ascites after the cerebrospinal fluid diversion procedure, though it has not been reported. Here, we present the case of a patient with non-small cell lung cancer with leptomeningeal metastasis in whom malignant ascites developed after a subduroperitoneal shunt.

Keywords: Leptomeningeal metastasis; Malignant ascites; Ventriculoperitoneal shunt.

Fig. 1

Axial T1-weighted contarst-enhanced MRI shows subdural fluid collection around the left cerebral hemisphere resulting in midline shift and asymmetrical ventricles. Also, tissue defect from previous surgical resection of the metastatic lesion is shown in left parietal area. MRI : magnetic resonance image.

Fig. 2

A : Brain CT scan after subduroperitoneal shunt shows a subdural catheter around the left cerebral hemisphere and demonstrates communication between subdural space and previous tumor resection cavity by pneumocephalus in both space. B : Plain X-ray image of abdomen shows a distal shunt catheter within peritoneal cavity. CT : computed tomography.

Fig. 3

Ultrasonography reveals a large amount of ascites in the abdominal and pelvic cavity.