Anterior images. Top row images (obtained with patient supine); middle two row images (obtained after patient sitting for 5 minutes); bottom two images (obtained after patient sitting for another 4 mintues)
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Full history/Diagnosis is available below
Flow into the shunt improves after the patient sits for 5 minutes. The subsequent images demonstrate flow into the distal limb in the head, neck and upper chest. A more intense focal collection in the shunt localizes at the site of the patient’s focal neck swelling.
Because images confirmed that a CSF leak site was present in the neck, images to evaluate the intra-peritoneal segment of the shunt were not performed.
Although CSF leakage can occur following trauma, typical sites are from the paranasal or mastoid sinuses. Leakage of CSF from a shunt, a more rare occurrence, can be due to catheter disconnecting from the resevoir or catheter fracture. Leaks can be intermittent and can occur with changes in patient position. Findings with a CSF leak are “extravasation” or collections of radiotracer in a abnormal location outside the cerebrospinal space.
In this case, the patient’s abnormal neck swelling was due to leakage of CSF from a disrupted shunt.
View followup image(ct). This axial CT examination was obtained the same day as the CSF shunt scintigraphy examination. This select axial post contrast CT of the neck was obtained in the region of the left neck swelling. Note fluid density collection posterior and adjacent to left shunt tubing, superficial to the left sternocleidomastoid muscle. Incidentally noted is an older, nonfunctioning shunt posterior to this malfunctioned shunt. No cervical adenopathy was appreciated.
References and General Discussion of CSF Shunt Scintigraphy (Anatomic field:Spine and Contents, Category:Misc)
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