Alkhudari Anas,  Galal Maad,  Aljabr Aljoharah

Final Pr. ID: Poster #: CR-004

In the treatment of infant hydrocephalus, ventriculoperitoneal (VP) shunts are considered the standard of care. Various complications are associated with VP shunting. Ventriculoperitoneal shunt catheter migration remains a rare but documented complication seen in one in 1000 patients who receive a VP shunt. Migration of the VP shunt into the scrotum is even more uncommon and requires surgical treatment.

We report a unique case of a 6-month-old preterm male with history of hydrocephalus treated with surgically placed VP shunt. He presented with vomiting and was found to have a right inguinoscrotal sac swelling with the tip of the catheter appreciated upon palpation of the sac and later confirmed by abdominal radiograph. After admission, the patient started to show rapid and significant improvement without significant intervention. On further imaging, the positioning of the VP shunt improved with a sufficiently reduced tip highlighting the spontaneous reduction of the distal catheter tip. Repeated imaging months later showed no recurrence.

Scrotal migrations are more common in children, and this is commonly thought to be due to an unobliterated processus vaginalis allowing the catheter tip to enter the scrotal sac. As most patients remain asymptomatic and present only after an exacerbation with co-infections, the importance of early diagnosis should not be neglected. This is crucial to avoid subsequent complications such as acute hydrocephalus, testicular torsion, and peritoneal perforation. For nearly all scrotal VP shunt migration cases, definitive treatment is surgical with manual repositioning followed by hernia repair. VP shunt migration should remain an essential differential of scrotal masses in that patient population. We also want to raise awareness to radiologists about the malposition of the VP shunt catheter and the rare ability for it to reduce and retract into appropriate positioning spontaneously. We believe that these recommendations will help improve quality of care management in pediatric hydrocephalus patients. Read More

Authors:  Alkhudari Anas , Galal Maad , Aljabr Aljoharah

Keywords:  Hydrocephalus, Ventriculoperitoneal Shunt Migration, Scrotal Sac Swelling

Oztek Murat Alp,  Parisi Marguerite,  Perez Francisco,  Phillips Grace

Final Pr. ID: Poster #: EDU-065

Ventricular shunt failures are common with as many as 40% failing by 1 year and 70% by 10 years. Approximately 15% of these shunt failures are related to shunt disconnections. The typical presenting symptoms of shunt malfunction are nonspecific and include nausea, vomiting, and altered consciousness; therefore, imaging is critical for diagnosis. Conventional radiographs can be used to identify shunt disruption although they can have limited sensitivity. Most children with suspected shunt dysfunction will also undergo CT or MR imaging to evaluate ventricular sizes. In addition, the integrity of the shunt system within the field of view on head CT can be assessed in detail; however, subtle shunt disconnections or fractures can still be difficult to detect on multiplanar CT images. Volume rendered CT images of the shunt apparatus can be used to improve the detection of subtle shunt disruptions Read More

Authors:  Oztek Murat Alp , Parisi Marguerite , Perez Francisco , Phillips Grace

Keywords:  Ventriculoperitoneal shunt, CT, Volume rendering

Ramírez Tamara,  Abdeen Nishard

Final Pr. ID: Poster #: SCI-027

The optic nerve sheath diameter (ONSD) has been noted to distend in patients with increased intracranial pressure. There is relatively little data on the sensitivity of dilated optic nerve sheath on initial CT or MRI as a sign of raised Intracranial pressure (ICP) in children with ventriculoperitoneal (VP) shunt malfunction. This pilot study aims to establish if there is a significant difference in ONSD pre- and postshunt revision surgery. Read More

Authors:  Ramírez Tamara , Abdeen Nishard

Keywords:  Optic nerve sheath diameter, Intracranial pressure, Ventriculoperitoneal shunt

Hallaji Shareh,  Collins John,  Ritter Ann,  Tye Gary,  Vorona Gregory

Final Pr. ID: Poster #: EDU-080

Shunts are near-ubiquitous in the world of pediatric neuroimaging, and it is incumbent on radiologists who interpret pediatric neuroimaging to have a basic understanding of the different shunt types and components. In this educational poster we will review the appearance of a shunt with its three parts. We will correlate this to the imaging appearance of different shunt valves (programmable and non-programmable), and appropriate proximal and distal catheter positioning. We will describe the more common complications (i.e. shunt failure, subdural collections, slit ventriclular syndrome, etc.) associated with shunts in pediatric patients. The poster will also briefly highlight some of the relative advantages and disadvantages of computed tomography (CT) and magnetic resonance (MR) imaging in the assessment of hydrocephalus. Read More

Authors:  Hallaji Shareh , Collins John , Ritter Ann , Tye Gary , Vorona Gregory

Keywords:  shunts, ventriculoperitoneal