Case Author(s): Michael Roarke, M.D. and Barry A. Siegel, M.D. , 3/9/96 . Rating: #D3, #Q4

Diagnosis: Obstructed Ventriculoperitoneal Shunt

Brief history:

3-month old girl with hydrocephalus and loculated fluid collection in the abdomen on ultrasonography.


Anterior and lateral images of the head.

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Full history/Diagnosis is available below

Diagnosis: Obstructed Ventriculoperitoneal Shunt

Full history:

3-month old girl with history of jejunal atresia status post surgical repair and subsequent development of hydrocephalus. A ventriculoperitoneal shunt was placed on 12-5-95, complicated by pseudocyst formation at the distal tip of the peritoneal limb secondary to adhesions.


Tc-99m DTPA


At 20 minutes following injection of tracer into the shunt reservoir, activity is seen in the proximal limb tubing only. At 40 minutes, activity is seen in the lateral ventricles, and third and fourth ventricles, as well as extending down the spinal canal. Still, no activity is seen in the distal shunt limb. Sonographic examination confirms the presence of a loculated fluid collection within the abdomen at the site of the distal limb tip.


Patency of the distal limb of a ventriculoperitoneal shunt catheter is indicated by free peritoneal spill of activity. The absence of distal limb tracer activity at 40 minutes in this examination, despite pumping the reservoir valve, indicates distal limb obstruction. The patient subsequently underwent conversion to a ventriculoatrial shunt.

ACR Codes and Keywords:

References and General Discussion of CSF Shunt Scintigraphy (Anatomic field:Skull and Contents, Category:Normal, Technique, Congenital Anomaly)

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Case number: cs002

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