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38-YEAR-OLD MAN WITH DANDY-WALKER SYNDROME
Authored By: Tom Miller and Asif Moinuddin.
Patient: 38 year old male
History: HISTORY:
38-year-old man with hydrocephalus due to Dandy-Walker Syndrome.

 
Image Size:[small][as-submitted]

Multimedia: 90857_1_submitted.avi

Fig. 2
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Findings:

RADIOPHARMACEUTICAL:
0.71 mCi Tc-99m DTPA was injected into the reservoir of the shunt system.


FINDINGS: The radiopharmaceutical was injected into the reservoir of the shunt system by a physician from the Department of Neurosurgery. Dynamic images were performed for 15 minutes. Images of the head were acquired for the first 3 minutes and imaging of the thorax were performed during the remaining 12 minutes of the study. Initial images demonstrate activity in the reservoir along with prompt descent of activity in the tubing system of the ventriculopleural shunt. At the beginning of the 5th minute, the activity enters the right pleural space. By the end of 15 minutes activity is diffusely present within the right pleural cavity.

Diagnosis: DIAGNOSIS: Patent ventriculopleural shunt
General Discussion:

FULL HISTORY:
38-year-old man with Dandy-Walker Syndrome and hydrocephalus. He has undergone multiple ventriculoperitoneal shunt revisions. Due to poor abdominal absorption, adhesions and infections, the decision was made to convert the ventriculoperitoneal shunt to a ventriculopleural shunt. We were asked to evaluate for shunt patency.

DISCUSSION:
Dandy-Walker Syndrome* is a congenital brain malformation involving the cerebellum and ventricles. Presenting symptoms vary with age. This syndrome is association with other central nervous system disorders, including absent corpus callosum and other morphological malformations including heart, face, limbs, fingers and toes are also commonly described. Hydrocephalus is treated by shunting the CSF, most commonly into the peritoneal cavity. Alternatively, CSF can be diverted to the atrium or pleural space. The very first documented report of a ventriculopleural shunt was described in 1914 by Heile et al**, in the management of hydrocephalus. Currently, ventriculopleural diversions*** are commonly performed in cases of infected ventriculoperitoneal shunts. Small pleural effusions are commonly seen but usually are asymptomatic.


Specific Discussion:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
References: *http://www.ninds.nih.gov/disorders/dandywalker/dandywalker.htm
**Heile et al;Arch Klin Chir 105:501-516,1914
*** Jones et al; Ventriculopleural shunts for hydrocephalus: A useful alternative; Neurosurgery,Vol 23, No.6 1988
Comments:
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Additional Details:

Case Number: 90857Owner(s): Tom Miller and Asif MoinuddinLast Updated: 02-07-2013
Anatomy: Cranium and Contents   Pathology: Congenital
Modality: Nuc MedAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: csnm, ventriculo-pleural, hydrocephalus, shuntACR: 10000.14500

Case has been viewed 71 times.
Certified by Tom Miller on 04-18-2007

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