How crucial is it to look at the VP shunt on a chest X-ray?
Small breaks can be easily missed and can have complications later. It is always a good practise to look at shunts carefully on radiographs, as with any other lines and tubes.
How to identify that it is a CSF pseudocyst?
By carefully looking at the adjacent VP shunt for any break or discontinuity.
CT scan images show a lobulated CSF pseudocyst with an adjacent break in the VP shunt.