Case of the Week: March 24-March 31, 2011

9 year old with ventriculo peritoneal shunt

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Case Details

Plain film of the abdomen shows soft tissue fullnees in the pelvis. Ultrasound confirmed large fluid collection of CSF with shunt in the middle of the collection

Answer

Diagnosis: CSF-oma

CSF-oma is a loculation of cerebrospinal fluid (CSF) at the distal end of the Ventriculoperitoneal shunt tube.

 

It may occur secondary to adhesions and results in an enlarging abdominal and or /pelvic mass at the catheter tip, as CSF from the tip is no longer absorbed by the peritoneum.

 

CSF-oma can resolve spontaneously or after shunt revision or repostion.

 

Complications include infection and obstruction.

 

Infection rate is 30% and can be higher in younger children.

 

Causes of Shunt Malfunction:

Mechanical failure of the shunt

Obstruction

Disconnection

Migration

Equipment failure

Fracture of tubing

  

Shunt infection

  Locations of Shunt Catheter Migration:

Scrotum

Internal jugular vein

Umbilicus

Stomach

Mouth

Vagina

Intestine

Chest

Liver

Anus

Coronary sinus

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