1
|
Di Salle G, Migaleddu G, Canovetti S, Liberti G, Perrini P, Cosottini M. Rare Complications of CSF Diversion: Paradoxical Neuroimaging Findings in a Double, Chiasmic Case Report. Diagnostics (Basel) 2024; 14:1141. [PMID: 38893666 PMCID: PMC11172121 DOI: 10.3390/diagnostics14111141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Two patients with CSF shunting systems exhibited symptoms of altered intracranial pressure. Initial neuroimaging led to misinterpretation, but integrating clinical history and follow-up imaging revealed the true diagnosis. In the first case, reduced ventricular size was mistaken for CSF overdrainage, while the actual problem was increased intracranial pressure, as seen in slit ventricle syndrome. In the second case, symptoms attributed to intracranial hypertension were due to CSF overdrainage causing tonsillar displacement and hydrocephalus. Adjusting the spinoperitoneal shunt pressure resolved symptoms and imaging abnormalities. These cases highlight the necessity of correlating clinical presentation with a deep understanding of CSF dynamics in shunt assessments.
Collapse
Affiliation(s)
- Gianfranco Di Salle
- Academic Radiology, Department of Translational Research, University of Pisa, Via Roma 67, 56126 Pisa, Italy;
| | | | - Silvia Canovetti
- Neuroradiology Unit, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy;
| | - Gaetano Liberti
- Neurosurgery Unit, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy
| | - Paolo Perrini
- Neurosurgery Unit, Azienda Ospedaliero Universitaria Pisana, 56124 Pisa, Italy
- Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| | - Mirco Cosottini
- Neuroradiology Unit, Department of Translational Research on New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy
| |
Collapse
|
2
|
Wang P, Dona A, Khetarpal N, Reeder S, Robertson J, Patel S. EEG Correlates of Spikes in Intracranial Pressure Caused by Transient Ventriculoperitoneal Shunt Malfunction. J Clin Neurophysiol 2023; 40:562-565. [PMID: 36893379 DOI: 10.1097/wnp.0000000000001002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
SUMMARY A 30-year-old man with recurrent headaches and seizure-like activity and a 26-year-old woman with worsening headaches were admitted to the hospital. Both had ventriculoperitoneal shunts and history of several shunt revisions for congenital hydrocephalus. The ventricle size visualized on computed tomography scans was unremarkable, and shunt series were negative in both cases. Both patients began to present with brief periods of unresponsiveness, and video electroencephalography at that time showed periods of diffuse delta slowing. Lumbar punctures revealed increased opening pressures. Despite normal imaging and shunt series, both patients ultimately had increased intracranial pressure caused by shunt malfunction. This series demonstrates the difficulty of diagnosing potential transient increases in intracranial pressure based on standard-of-care diagnostics/examination and the potentially critical role for EEG in the identification of shunt malfunction.
Collapse
Affiliation(s)
- Paul Wang
- University of Minnesota Medical School, University of Minnesota, Minneapolis, Minnesota, U.S.A
- Center for Magnetic Resonance Research and Department of Radiology, University of Minnesota, Minneapolis, Minnesota, U.S.A
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Allison Dona
- University of Minnesota Medical School, University of Minnesota, Minneapolis, Minnesota, U.S.A
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, Minnesota, U.S.A
| | - Nikita Khetarpal
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, U.S.A.; and
| | - Stephanie Reeder
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, U.S.A.; and
| | - Jetter Robertson
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, U.S.A.; and
| | - Sima Patel
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, U.S.A.; and
| |
Collapse
|
3
|
Shrestha N, Gautam N, Shrestha M. Abdominal pseudocyst complicating ventriculoperitoneal shunt: A rare indication for ventriculopleural shunt conversion. Clin Case Rep 2023; 11:e7902. [PMID: 37692158 PMCID: PMC10485240 DOI: 10.1002/ccr3.7902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/19/2023] [Accepted: 08/28/2023] [Indexed: 09/12/2023] Open
Abstract
Key Clinical Message Abdominal pseudocyst is a rare complication of ventriculoperitoneal (VP) shunt placement. Ventriculopleural shunt (VPL) can be an effective treatment option for the recurrent complications of VP shunt failure. Abstract Abdominal pseudocyst (APC) is a rare complication of ventriculoperitoneal (VP) shunt placement for the treatment of congenital hydrocephalus. This case report presents a two-and-a-half-year-old male child who underwent VP shunt placement for aqueductal stenosis-related hydrocephalus. The patient subsequently developed recurrent shunt failure and an APC, which was managed initially by surgical excision of the cyst and repositioning of the catheter. However, shunt failure recurred. The patient underwent ventriculopleural (VPL) shunt conversion as a more viable option for recurrent blockage. Postoperatively, the patient developed respiratory distress with massive pleural effusion, which was treated with chest tube insertion. This case highlights the complexity of managing congenital hydrocephalus and its rare complication, APC. Prompt recognition and appropriate management of APC can lead to improved outcomes and minimize the need for invasive procedures. VPL shunt conversion can be considered an alternative treatment option when other treatments have failed. Further research is needed to establish guidelines for the management of APC and determine the long-term effectiveness of VPL shunting.
Collapse
Affiliation(s)
- Nishan Shrestha
- Intern doctorTribhuvan University Teaching HospitalKathmanduNepal
| | - Naveen Gautam
- Intern doctorTribhuvan University Teaching HospitalKathmanduNepal
| | - Merina Shrestha
- PaediatricsTribhuvan University Teaching HospitalKathmanduNepal
| |
Collapse
|
4
|
Liţescu M, Cristian DA, Coman VE, Erchid A, Pleşea IE, Bordianu A, Lupaşcu-Ursulescu CV, Florea CG, Coman IS, Grigorean VT. Right Transcephalic Ventriculo-Subclavian Shunt in the Surgical Treatment of Hydrocephalus-An Original Procedure for Drainage of Cerebrospinal Fluid into the Venous System. J Clin Med 2023; 12:4919. [PMID: 37568321 PMCID: PMC10419378 DOI: 10.3390/jcm12154919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/02/2023] [Accepted: 07/19/2023] [Indexed: 08/13/2023] Open
Abstract
The objectives of this article are to present an original surgical procedure for the temporary or definitive resolution of hydrocephalus, in the case of repeated failure of standard treatment techniques, and to present a case that was resolved using this surgical technique. MATERIALS AND METHODS We present the case of a 20-year-old male patient with congenital hydrocephalus who underwent a number of 39 shunt revisions, given the repetitive dysfunctions of various techniques (ventriculo-peritoneal shunt, ventriculo-cardiac shunt). The patient was evaluated with the ventricular catheter externalized at the distal end and it was necessary to find an emergency surgical solution, considering the imminent risk of meningitis. The patient was also associated with the diagnosis of acute lithiasic cholecystitis. RESULTS AND DISCUSSIONS The final chosen solution, right ventriculo-venous drainage using the cephalic vein, was a temporary surgical solution, but there are signs that this procedure can provide long-term ventricular drainage. CONCLUSIONS Transcephalic ventriculo-subclavian drainage represents an alternative technical option, which can be used when established options become ineffective.
Collapse
Affiliation(s)
- Mircea Liţescu
- Discipline of Surgery and General Anesthesia—“Sf. Ioan” Clinical Emergency Hospital, 2nd Department, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania;
- General Surgery Department, “Sf. Ioan” Clinical Emergency Hospital, 13 Vitan-Bârzeşti Road, 042122 Bucharest, Romania
| | - Daniel Alin Cristian
- Discipline of General Surgery—“Colţea” Clinical Hospital, 10th Department—General Surgery, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania;
- General Surgery Department, “Colţea” Clinical Hospital, 1 Ion C. Brătianu Boulevard, 030167 Bucharest, Romania
| | - Violeta Elena Coman
- Discipline of General Surgery—“Bagdasar-Arseni” Clinical Emergency Hospital, 10th Department—General Surgery, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania; (V.E.C.); (V.T.G.)
- General Surgery Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania; (A.E.); (C.G.F.)
| | - Anwar Erchid
- General Surgery Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania; (A.E.); (C.G.F.)
| | - Iancu Emil Pleşea
- Pathology Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania;
| | - Anca Bordianu
- Discipline of Plastic and Reconstructive Surgery—“Bagdasar-Arseni” Clinical Emergency Hospital, 9th Department—Plastic and Reconstructive Surgery, Pediatric Surgery, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania;
- Plastic Surgery and Reconstructive Microsurgery Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania
| | - Corina Veronica Lupaşcu-Ursulescu
- Discipline of Radiology and Medical Imagistics, 2nd Surgery Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iaşi, Romania;
- Radiology and Medical Imagistics Department, “Sf. Spiridon” County Emergency Hospital, 1 Independenţei Boulevard, 700111 Iaşi, Romania
| | - Costin George Florea
- General Surgery Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania; (A.E.); (C.G.F.)
| | - Ionuţ Simion Coman
- Discipline of General Surgery—“Bagdasar-Arseni” Clinical Emergency Hospital, 10th Department—General Surgery, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania; (V.E.C.); (V.T.G.)
- General Surgery Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania; (A.E.); (C.G.F.)
| | - Valentin Titus Grigorean
- Discipline of General Surgery—“Bagdasar-Arseni” Clinical Emergency Hospital, 10th Department—General Surgery, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 37 Dionisie Lupu Street, 020021 Bucharest, Romania; (V.E.C.); (V.T.G.)
- General Surgery Department, “Bagdasar-Arseni” Clinical Emergency Hospital, 12 Berceni Road, 041915 Bucharest, Romania; (A.E.); (C.G.F.)
| |
Collapse
|
5
|
Hamed EA, Mohammad SA, Awadallah SM, Abdel-Latif AMM, Abd-Elhameed AM. MRI as a one-stop destination for evaluation of CSF shunt malfunction. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2023. [DOI: 10.1186/s43055-023-00991-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Abstract
Background
Despite the high-frequency rate of cerebrospinal fluid shunt malfunction, radiological evaluation of CSF shunts has remained deficient, focusing mainly on demonstrating secondary signs of shunt failure rather than evaluating the shunt tube itself. We aimed to study the utility of different MR pulse sequences in evaluating the cranial and abdominal ends of CSF shunts in order to identify the potential cause of shunt failure and its impact on patient management.
Results
Twenty-five patients (18 males, 7 females, median age 2.5 years, IQR 0.75–15) were enrolled in the study, having 28 ventriculo-peritoneal shunts and single ventriculo-gallbladder shunt. The catheter lumen and fine intraventricular septae were only demonstrated in 3D-DRIVE sequences (p < 0.001). Except for three patients (having cranial end-related complications), all patients with cranial and/or abdominal end-related complications received surgery (p < 0.001, positive likelihood and negative likelihood ratios = 7.27, 0.3, respectively, sensitivity = 0.7 and specificity = 0.9). MRI findings (luminal occlusion, disconnection, CSF collection, or migration) were consistent with operative data. There is no significant difference between patients who underwent surgery and those with conservative management, or symptomatic and asymptomatic patients in terms of the prevalence of ventricular dilatation or white matter signal abnormality. The results of the abdomino-pelvic fat-suppressed T2-WI showed excellent agreement with ultrasound findings (Cohen’s Kappa 0.9). Quantitative PC could give insights into CSF dynamics, which depend on the site and cause of shunt malfunction.
Conclusions
MRI could be a one-stop destination for evaluating patients with suspected non-acute shunt malfunction. It was found to have clinical relevance in terms of accurately locating the exact site and possible cause of shunt-related complications.
Collapse
|
6
|
Hodges H, Epstein KN, Retrouvey M, Wang SS, Richards AA, Lima D, Revels JW. Pitfalls in the interpretation of pediatric head CTs: what the emergency radiologist needs to know. Emerg Radiol 2022; 29:729-742. [PMID: 35394570 DOI: 10.1007/s10140-022-02042-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022]
Abstract
Pediatric radiology studies can be some of the most anxiety-inducing imaging examinations encountered in practice. This can be in part due to the wide range of normal anatomic appearances inherent to the pediatric population that create potential interpretive pitfalls for radiologists. The pediatric head is no exception; for instance, the inherent greater water content within the neonatal brain compared to older patients could easily be mistaken for cerebral edema, and anatomic variant calvarial sutures can be mistaken for skull fractures. This article reviews potential pitfalls emergency radiologists may encounter in practice when interpreting pediatric head CTs, including trauma, extra-axial fluid collections, intra-axial hemorrhage, and ventriculoperitoneal shunt complications.
Collapse
Affiliation(s)
- Hannah Hodges
- Department of Radiology, University of New Mexico, MSC 10 5530, 1, Albuquerque, NM, 87131, USA
| | - Katherine N Epstein
- Department of Radiology, University of New Mexico, MSC 10 5530, 1, Albuquerque, NM, 87131, USA
| | - Michele Retrouvey
- Department of Radiology, Eastern Virginia Medical School, Diagnostic Radiology, P.O. Box 1980, Norfolk, VA, 23501, USA
| | - Sherry S Wang
- Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East #1A71, Salt Lake City, UT, 84132, USA
| | - Allyson A Richards
- Department of Radiology, University of New Mexico, MSC 10 5530, 1, Albuquerque, NM, 87131, USA
| | - Dustin Lima
- Department of Radiology, University of New Mexico, MSC 10 5530, 1, Albuquerque, NM, 87131, USA
| | - Jonathan W Revels
- Department of Radiology, University of New Mexico, MSC 10 5530, 1, Albuquerque, NM, 87131, USA.
| |
Collapse
|
7
|
Improving the detection of ventricular shunt disruption using volume-rendered three-dimensional head computed tomography. Pediatr Radiol 2022; 52:549-558. [PMID: 34535807 DOI: 10.1007/s00247-021-05190-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/15/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
Hydrocephalus is the most common neurosurgical disorder in children, and cerebrospinal fluid (CSF) diversion with shunt placement is the most commonly performed pediatric neurosurgical procedure. CT is frequently used to evaluate children with suspected CSF shunt malfunction to assess change in ventricular size. Moreover, careful review of the CT images is important to confirm the integrity of the imaged portions of the shunt system. Subtle shunt disruptions can be missed on multiplanar two-dimensional (2-D) CT images, especially when the disruption lies in the plane of imaging. The use of volume-rendered CT images enables radiologists to view the extracranial shunt tubing within the field of view as a three-dimensional (3-D) object. This allows for a rapid and intuitive method of assessing the integrity of the extracranial shunt tubing. The purpose of this pictorial essay is to discuss how volume-rendered CT images can be generated to evaluate CSF shunts in the pediatric population and to provide several examples of their utility in diagnosing shunt disruption. We also address the potential pitfalls of this technique and ways to avoid them.
Collapse
|
8
|
De Jesus O, Rios-Vicil C, Pellot Cestero JE, Carro-Figueroa EF. Huge subcutaneous extraperitoneal pseudocyst after migration of the ventriculoperitoneal shunt catheter. BMJ Case Rep 2021; 14:e246681. [PMID: 34853048 PMCID: PMC8638129 DOI: 10.1136/bcr-2021-246681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/03/2022] Open
Abstract
The formation of an intraperitoneal pseudocyst as a complication of ventriculoperitoneal shunts is well known. However, the formation of a pseudocyst at the subcutaneous extraperitoneal abdominal space is unusual and likely secondary to the migration of the peritoneal catheter. We present a 53-year-old male who had placement of a ventriculoperitoneal shunt for hydrocephalus secondary to a vestibular schwannoma. Five months later, he presented with an enormously distended abdomen. Investigations showed the peritoneal catheter in the extraperitoneal space within a large right lower quadrant abdominal wall pseudocyst. The patient was taken to the operating theatre, and the shunt was externalised at the original abdominal incision. Approximately 3 L of cerebrospinal fluid were aspirated from the distal peritoneal catheter. After negative cultures, a new peritoneal catheter was placed intraperitoneally at the contralateral lower abdominal quadrant. The contralateral quadrant was utilised to prevent fluid accumulation into the old extraperitoneal cavity.
Collapse
Affiliation(s)
- Orlando De Jesus
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, Puerto Rico
| | - Christian Rios-Vicil
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, Puerto Rico
| | - Joel E Pellot Cestero
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, Puerto Rico
| | - Eric F Carro-Figueroa
- Neurosurgery, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico, Puerto Rico
| |
Collapse
|
9
|
Udayakumaran S, Pillai S, Dwarakanath S, Bhattacharjee S, Mehrotra N, Raju S, Gupta D, Panigrahi M, Venkataramana NK, Rajshekhar V, Sankhla S. Indian Society of Pediatric Neurosurgery Consensus Guidelines on Preventing and Managing Shunt Infection: Version 2020-21. Neurol India 2021; 69:S526-S555. [PMID: 35103012 DOI: 10.4103/0028-3886.332268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Shunt infection is the most significant morbidity associated with shunt surgery. Based on the existing literature for the prevention and management of shunt infection, region and resource-specific recommendations are needed. Methods In February 2020, a Guidelines Development Group (GDG) was created by the Indian Society of Paediatric Neurosurgery (IndSPN) to formulate guidelines on shunt infections, which would be relevant to our country and LMIC in general. An initial email survey identified existing practices among the membership of the IndSPN, and eight broad issues pertaining to shunt infection were identified. Next, members of the GDG performed a systematic review of the literature on the prevention and management of shunt infection. Then, through a series of virtual meetings of the GDG over 1 year, evidence from the literature was presented to all the members and consensus was built on different aspects of shunt infection. Finally, the guidelines document was drafted and circulated among the GDG for final approval. Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to grade the evidence and strength of recommendation. Results The guidelines are divided into eight sections. Level I and Level II evidence was available for only five recommendations and led to a moderate level of recommendations. Most of the available evidence was at Level III and below, and hence the level of recommendation was low or very low. A consensus method was used to provide recommendations for several issues. Conclusions Although most of the recommendations for the prevention and management of shunt infections are based on a low level of evidence, we believe that this document will provide a useful reference to neurosurgeons not only in India but also in other low and middle income countries. These guidelines need to be updated as and when new evidence emerges.
Collapse
Affiliation(s)
- Suhas Udayakumaran
- Division of Paediatric Neurosurgery, Department of Neurosurgery, Amrita Institute Of Medical Sciences and Research Centre, Kochi, Kerala, India
| | - Shibu Pillai
- Department of Neurosurgery, Narayana Institute of Neurosciences, Bengaluru, Karnataka, India
| | - Srinivas Dwarakanath
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suchanda Bhattacharjee
- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Naveen Mehrotra
- Consultant Neurosurgeon, Sunshine Hospitals, Secunderabad, Telangana, India
| | - Subodh Raju
- Institute of Neurosciences, AIG Hospitals, Hyderabad, Telangana, India
| | - Deepak Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manas Panigrahi
- Department of Neurosurgery, Krishna Institute of Medical Science, Hyderabad, Telangana, India
| | | | - Vedantam Rajshekhar
- Department of Neurological Sciences, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Suresh Sankhla
- Department of Neurosurgery, Global Hospital, Mumbai, Maharashtra, India
| |
Collapse
|
10
|
Sayore CM, Hemama M, de Paule Kossi Adjiou F, Moune MY, Sabur S, El Fatemi N, El Maaqili R. Thoracic abscess due to unusual migration of a ventriculoperitoneal shunt and literature review. Surg Neurol Int 2021; 12:467. [PMID: 34621582 PMCID: PMC8492440 DOI: 10.25259/sni_699_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 08/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Thoracic complications of ventriculoperitoneal (VP) cerebrospinal fluid shunting are rare and the diagnosis is difficult without neurological impairment. Case Description: We report a case of a 36-year-old woman who had a VP shunt in the right side when she was 13 years for a posterior fossa ependymoma and hydrocephalus. 23 years after surgery, she developed acute yellowfish cough and sputum, and the computed tomography scan found an intrathoracic cyst. She had a thoracotomy for the cyst and during surgery, we found the peritoneal catheter of the VP shunt, with a collected abscess in the left side. The patient was treated for the abscess and the VP shunt was removed. We also review the literature cases of thoracic complications after VP shunts. Conclusion: Thoracic abscess due to VP shunt migration is extremely rare and could happen after a long time delay VP shunt surgery.
Collapse
Affiliation(s)
| | | | | | | | - Safa Sabur
- Department of thoracic surgery, Chu Ibn Sina Rabat, Rabat, Morocco
| | | | | |
Collapse
|
11
|
Sharma M, Mohan KR, Kumar S, Kumar KM. "Shunt Pumping Test": role of practice on an experimental model. Childs Nerv Syst 2021; 37:2807-2811. [PMID: 34131768 DOI: 10.1007/s00381-021-05221-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To ascertain the benefits of practicing shunt pumping test on a validated experimental model. METHODS A validated experimental model of shunt was used and 25 medical professionals were asked to assess the block in the model where artificial blocks were created. The assessment was repeated after the participants had practiced on the same model. The performance of participants before and after practice was compared and statistically evaluated. RESULTS The ability to predict the status of shunt showed an improvement in all scenarios after practice. The odds ratio for predicting a blocked shunt before and after practice was 7.25 (95% credible interval: 1.50-21.01). The odds ratio for predicting a functional shunt before and after practice was 8.81 (95% credible interval of 1.64 to 13.65). CONCLUSION Practicing on the experimental model significantly improves the ability to predict the status of shunt. Training of primary caregivers on similar shunt models based on the shunts used in respective centers can improve an early detection of shunt block and reduce reliance on more invasive and expensive evaluation modalities.
Collapse
Affiliation(s)
- Manish Sharma
- Department of Neurosurgery, Army Hospital (R&R), Delhi Cantt, New Delhi, India.
| | - Karthik Ram Mohan
- Department of Paediatrics, Command Hospital (EC) Kolkata, Kolkata, India
| | - Suman Kumar
- Department of Clinical Haematology, Army Hospital (R&R), Delhi Cantt, New Delhi, India
| | - Krishna M Kumar
- Department of Anaesthesia and Critical Care, Command Hospital (EC) Kolkata, Kolkata, India
| |
Collapse
|
12
|
Ryan DJ, Kavanagh RG, Joyce S, O'Callaghan Maher M, Moore N, McMahon A, Hussey D, O'Sullivan MGJ, Wyse G, Fanning N, O'Connor OJ, Maher MM. Development and implementation of an ultralow-dose CT protocol for the assessment of cerebrospinal shunts in adult hydrocephalus. Eur Radiol Exp 2021; 5:26. [PMID: 34180040 PMCID: PMC8236421 DOI: 10.1186/s41747-021-00222-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background Cerebrospinal fluid shunts in the treatment of hydrocephalus, although associated with clinical benefit, have a high failure rate with repeat computed tomography (CT) imaging resulting in a substantial cumulative radiation dose. Therefore, we sought to develop a whole-body ultralow-dose (ULD) CT protocol for the investigation of shunt malfunction and compare it with the reference standard, plain radiographic shunt series (PRSS). Methods Following ethical approval, using an anthropomorphic phantom and a human cadaveric ventriculoperitoneal shunt model, a whole-body ULD-CT protocol incorporating two iterative reconstruction (IR) algorithms, pure IR and hybrid IR, including 60% filtered back projection and 40% IR was evaluated in 18 adult patients post new shunt implantation or where shunt malfunction was suspected. Effective dose (ED) and image quality were analysed. Results ULD-CT permitted a 36% radiation dose reduction (median ED 0.16 mSv, range 0.07–0.17, versus 0.25 mSv (0.06–1.69 mSv) for PRSS (p = 0.002). Shunt visualisation in the thoracoabdominal cavities was improved with ULD-CT with pure IR (p = 0.004 and p = 0.031, respectively) and, in contrast to PRSS, permitted visualisation of the entire shunt course (p < 0.001), the distal shunt entry point and location of the shunt tip in all cases. For shunt complications, ULD-CT had a perfect specificity. False positives (3/22, 13.6%) were observed with PRSS. Conclusions At a significantly reduced radiation dose, whole body ULD-CT with pure IR demonstrated diagnostic superiority over PRSS in the evaluation of cerebrospinal fluid shunt malfunction. Supplementary Information The online version contains supplementary material available at 10.1186/s41747-021-00222-4.
Collapse
Affiliation(s)
- David J Ryan
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland.
| | - Richard G Kavanagh
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | - Stella Joyce
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | | | - Niamh Moore
- Department of Radiography, School of Medicine, Brookfield Health Sciences Complex, University College Cork, Cork, T12 AK54, Ireland
| | - Aisling McMahon
- Department of Medical Physics, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | - Deirdre Hussey
- Department of Neurosurgery, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | - Michael G J O'Sullivan
- Department of Neurosurgery, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | - Gerald Wyse
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | - Noel Fanning
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland.,School of Medicine, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Wilton, Cork city, T12 DC4A, Ireland.,School of Medicine, University College Cork, Cork, Ireland
| |
Collapse
|
13
|
Bettag C, von der Brelie C, Freimann FB, Thomale UW, Rohde V, Fiss I. In vitro testing of explanted shunt valves in hydrocephalic patients with suspected valve malfunction. Neurosurg Rev 2021; 45:571-583. [PMID: 34027574 PMCID: PMC8827297 DOI: 10.1007/s10143-021-01564-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 04/22/2021] [Accepted: 05/04/2021] [Indexed: 10/26/2022]
Abstract
Diagnosis of symptomatic valve malfunction in hydrocephalic patients treated with VP-Shunt (VPS) might be difficult. Clinical symptoms such as headache or nausea are nonspecific, hence cerebrospinal fluid (CSF) over- or underdrainage can only be suspected but not proven. Knowledge concerning valve malfunction is still limited. We aim to provide data on the flow characteristics of explanted shunt valves in patients with suspected valve malfunction. An in vitro shunt laboratory setup was used to analyze the explanted valves under conditions similar to those in an implanted VPS. The differential pressure (DP) of the valve was adjusted stepwise to 20, 10, 6, and 4 cmH2O. The flow rate of the explanted and the regular flow rate of an identical reference valve were evaluated at the respective DPs. Twelve valves of different types (Codman CertasPlus valve n = 3, Miethke Shuntassistant valve n = 4, Codman Hakim programmable valve n = 3, DP component of Miethke proGAV 2.0 valve n = 2) from eight hydrocephalic patients (four male), in whom valve malfunction was assumed between 2016 and 2017, were replaced with a new valve. Four patients suffered from idiopathic normal pressure (iNPH), three patients from malresorptive and one patient from obstructive hydrocephalus. Post-hoc analysis revealed a significant difference (p < 0.001) of the flow rate between each explanted valve and their corresponding reference valve, at each DP. In all patients, significant alterations of flow rates were demonstrated, verifying a valve malfunction, which could not be objectified by the diagnostic tools used in the clinical routine. In cases with obscure clinical VPS insufficiency, valve deficiency should be considered.
Collapse
Affiliation(s)
- Christoph Bettag
- Department of Neurosurgery, Georg-August-Universität Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
| | - Christian von der Brelie
- Department of Neurosurgery, Georg-August-Universität Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Florian Baptist Freimann
- Department of Neurosurgery, Georg-August-Universität Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Ulrich-Wilhelm Thomale
- Pediatric Neurosurgery, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Veit Rohde
- Department of Neurosurgery, Georg-August-Universität Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Ingo Fiss
- Department of Neurosurgery, Georg-August-Universität Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| |
Collapse
|
14
|
Mathew RP, Sam M, Alexander T, Patel V, Low G. Abdominal and pelvic radiographs of medical devices and materials- part 2: neurologic and genitourinary devices and materials. ACTA ACUST UNITED AC 2021; 26:160-167. [PMID: 32209503 DOI: 10.5152/dir.2019.19391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Radiographs of the abdomen and pelvis are routinely obtained as a standard part of clinical care for the abdomen and pelvis. Brisk advances in technology over the last few decades have resulted in a multitude of medical devices and materials. Recognizing and evaluating these devices on abdominal and pelvic radiographs are critical, yet increasingly a difficult endeavor. In addition, multiple devices serving different purposes may have a similar radiographic appearance and position causing confusion for the interpreting radiologist. The role of the radiologist is to not only identify accurately these medical objects, but also to confirm for their accurate placement and to recognize any complications that could affect patient care, management or even be potentially life threatening. An extensive online search of literature showed our review article to be the most comprehensive work on medical devices and materials of the abdomen and pelvis, and in this second part of our two-part series, we discuss in depth about the neurologic and genitourinary devices seen on abdominal and pelvic radiographs.
Collapse
Affiliation(s)
- Rishi Philip Mathew
- Department of Radiology and Diagnostic Imaging, University of Alberta School of Medicine and Dentistry, Edmonton, Canada
| | - Medica Sam
- Department of Radiology and Diagnostic Imaging, University of Alberta School of Medicine and Dentistry, Edmonton, Canada
| | - Timothy Alexander
- Department of Radiology and Diagnostic Imaging, University of Alberta School of Medicine and Dentistry, Edmonton, Canada
| | - Vimal Patel
- Department of Radiology and Diagnostic Imaging, University of Alberta School of Medicine and Dentistry, Edmonton, Canada
| | - Gavin Low
- Department of Radiology and Diagnostic Imaging, University of Alberta School of Medicine and Dentistry, Edmonton, Canada
| |
Collapse
|
15
|
Sharma J, Al-Katib S. A Rare Case of a CSF Pseudocyst Mimicking a Complex Hepatic Cyst. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2021. [DOI: 10.1055/s-0040-1716788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractCerebrospinal fluid (CSF) peritoneal pseudocysts are a rare complication of ventriculoperitoneal shunts. They can manifest with symptoms of shunt malfunction or, more commonly, vague symptoms of abdominal discomfort such as pain or distention. The imaging features of peritoneal CSF pseudocysts may be nonspecific. In this case, we report a peritoneal CSF pseudocyst, which was initially mistaken for a complex hepatic cyst on both ultrasonography and MRI. The correct diagnosis was confirmed with a shuntogram and CT of the abdomen.
Collapse
Affiliation(s)
- Jatin Sharma
- Department of Diagnostic Radiology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, United States
| | - Sayf Al-Katib
- Department of Diagnostic Radiology, William Beaumont Hospital Royal Oak, Royal Oak, Michigan, United States
| |
Collapse
|
16
|
König RE, Stucht D, Baecke S, Rashidi A, Speck O, Sandalcioglu IE, Luchtmann M. Phase‐Contrast MRI Detection of Ventricular Shunt CSF Flow: Proof of Principle. J Neuroimaging 2020; 30:746-753. [DOI: 10.1111/jon.12794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- Rebecca E. König
- Department of Neurosurgery, Medical Faculty Otto‐von‐Guericke University Magdeburg Magdeburg Germany
| | - Daniel Stucht
- Department of Biomedical Magnetic Resonance Otto‐von‐Guericke University Magdeburg Magdeburg Germany
- Institute of Biometrics and Medical Informatics, Medical Faculty Otto‐von‐Guericke University Magdeburg Magdeburg Germany
| | - Sebastian Baecke
- Institute of Biometrics and Medical Informatics, Medical Faculty Otto‐von‐Guericke University Magdeburg Magdeburg Germany
| | - Ali Rashidi
- Department of Neurosurgery, Medical Faculty Otto‐von‐Guericke University Magdeburg Magdeburg Germany
| | - Oliver Speck
- Department of Biomedical Magnetic Resonance Otto‐von‐Guericke University Magdeburg Magdeburg Germany
- Leibniz Institute for Neurobiology Magdeburg Germany
| | - I. Erol Sandalcioglu
- Department of Neurosurgery, Medical Faculty Otto‐von‐Guericke University Magdeburg Magdeburg Germany
| | - Michael Luchtmann
- Department of Neurosurgery, Medical Faculty Otto‐von‐Guericke University Magdeburg Magdeburg Germany
| |
Collapse
|
17
|
Management of Hydrocephalus in Children: Anatomic Imaging Appearances of CSF Shunts and Their Complications. AJR Am J Roentgenol 2020; 216:187-199. [PMID: 33112667 DOI: 10.2214/ajr.20.22888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. This article addresses the management of hydrocephalus and the CSF shunts used to treat this entity. CONCLUSION. CSF shunts have a high failure rate. Imaging plays a pivotal role in assessing CSF shunt failure and determining the need for surgical revision. An in-depth knowledge of CSF shunt components, their failure modes, and the corresponding findings on anatomic imaging studies is necessary to ensure timely diagnosis and prevent permanent neurologic damage.
Collapse
|
18
|
Hari-Raj A, Malthaner LQ, Shi J, Leonard JR, Leonard JC. United States emergency department visits for children with cerebrospinal fluid shunts. J Neurosurg Pediatr 2020; 27:23-29. [PMID: 33720677 DOI: 10.3171/2020.6.peds19729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE CSF shunt placement is the primary therapy for hydrocephalus; however, shunt malfunctions remain common and lead to neurological deficits if missed. There is a lack of literature characterizing the epidemiology of children with possible shunt malfunctions presenting to United States emergency departments (EDs). METHODS A retrospective study was conducted of the 2006-2017 National Emergency Department Sample. The data were queried using an exhaustive list of Current Procedural Terminology and International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision codes representing children with hydrocephalus diagnoses, diagnostic imaging for shunt malfunctions, and shunt-related surgical revision procedures. RESULTS In 2017, there were an estimated 16,376 ED visits for suspected shunt malfunction. Children were more commonly male (57.9%), ages 0-4 years (42.2%), and publicly insured (55.8%). Many did not undergo diagnostic imaging (37.2%), and of those who did, most underwent head CT scans (43.7%). Between 2006 and 2017, pediatric ED visits for suspected shunt malfunction increased 18% (95% CI 12.1-23.8). The use of MRI increased substantially (178.0%, 95% CI 176.9-179.2). Visits resulting in discharge home from the ED increased by 76.3% (95% CI 73.1-79.4), and those involving no surgical intervention increased by 32.9% (95% CI 29.2-36.6). CONCLUSIONS Between 2006 and 2017, ED visits for children to rule out shunt malfunction increased, yet there was a decline in surgical intervention and an increase in discharges home from the ED. Possible contributing factors include improved clinical criteria for shunt evaluation, alternative CSF diversion techniques, changing indications for shunt placement, and increased use of advanced imaging in the ED. ABBREVIATIONS CPT = Current Procedural Terminology; ED = emergency department; ETV = endoscopic third ventriculostomy; ICD-9 = International Classification of Diseases, Ninth Revision; ICD-10 = International Classification of Diseases, Tenth Revision; NEDS = National Emergency Department Sample.
Collapse
Affiliation(s)
| | - Lauren Q Malthaner
- 2The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus
| | - Junxin Shi
- 2The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus
| | - Jeffrey R Leonard
- 1The Ohio State University College of Medicine, Columbus.,3Division of Pediatric Neurosurgery, Nationwide Children's Hospital, Columbus; and
| | - Julie C Leonard
- 1The Ohio State University College of Medicine, Columbus.,2The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus.,4Division of Pediatric Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio
| |
Collapse
|
19
|
Akgun E, Akgun MY, Sager S, Kafadar AM. The contribution of SPECT/CT in patients with radionuclide shuntography through shunt dysfunction. Clin Neurol Neurosurg 2020; 196:105958. [PMID: 32485522 DOI: 10.1016/j.clineuro.2020.105958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Radionuclide CSF study is a simple, effective, and low-radiation-dose procedure for the assessment of shunt patency. With the help of CT image of single-photon emission computed tomography/computed tomography (SPECT/CT), the interpretation becomes more accurate and easier.The aim of this study was to compare the classical methods and 2D planar scintigraphic images with radionuclide shuntography fused SPECT/CT. METHODS Between 2015-2019 all hydrocephalic patients who underwent radionuclide shuntography and classical methods (cranial CT, USG and/or direct X-rays), for suspected VP shunt malfunction at our hospital were retrospectively enrolled in the study. Fusion with SPECT/CT is provided in all radionuclide shuntographies. Approximately 0.5-1 mCi diethylene-triaminepentaaceticacid (DTPA) was intrathecally injected. Images were collected as 5-second frames for the first minute, and 1-min frames for the second to the 30th min. Static whole body images were obtained as early (30 min) and delayed (120 min) images. SPECT/CT was performed in 120 min. RESULTS When the classical methods were evaluated in the operated patients, according to the direct radiographic findings, in only 17 patients had shunt dysfunction due to disconnection-kinking or laceration, was obtained.On the other hand,while67 shuntography were evaluated,65 of these patients (97%) whose intraoperative and shuntography findings were found to be compatible with each other. CONCLUSION The 3D SPECT images combined with the two-dimensional planar images added to the CT provide more accurate information and also provide detailed anatomical information. The patient's operation was performed successfully in one session in cooperation with the other surgical branches when needed.
Collapse
Affiliation(s)
- Elife Akgun
- HighSpecialized Hospital, Department Of Nuclear Medicine, Kirikkale, Turkey
| | - Mehmet Yigit Akgun
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department Of Neurosurgery, Istanbul, Turkey.
| | - Sait Sager
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department Of Nuclear Medicine, Istanbul, Turkey
| | - Ali Metin Kafadar
- Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Department Of Neurosurgery, Istanbul, Turkey
| |
Collapse
|
20
|
Jeong Y, Lee J, Kim KA, Park CM. Medical Devices of the Abdomen and Pelvis and Their Complications: A Radiologic Atlas. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2020; 81:863-885. [PMID: 36238189 PMCID: PMC9432218 DOI: 10.3348/jksr.2020.81.4.863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/30/2019] [Accepted: 10/20/2019] [Indexed: 11/15/2022]
Abstract
의료기구들이 발달하면서 복부 및 골반 내에 이식되거나 거치되는 의료기구들이 다양해졌다. 흔하게 사용되는 기구들의 영상의학 소견은 영상의학과 의사들에게 매우 익숙하지만, 상대적으로 사용 빈도가 낮거나 새로운 형태의 기구들의 영상의학 소견은 잘 알려져 있지 않다. 또한 환자에 대한 임상정보가 제한적일 경우 이런 새로운 형태의 의료기구들은 잘못 해석되거나 놓치기 쉽다. 그러므로 복부 및 골반 내 의료기구들의 영상의학 소견을 인지하는 것은 기구들의 올바른 위치를 평가하고, 이와 관련된 합병증을 평가하는데 있어 매우 중요하다. 본 논문에서는 다양한 복부 및 골반 내 의료기구들과 이와 관련된 합병증의 영상의학 소견을 소개하고자 한다.
Collapse
Affiliation(s)
- Yaewon Jeong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jongmee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyeong Ah Kim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Cheol Min Park
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| |
Collapse
|
21
|
Docter TA, Patel BH, Brennan JJ, Castillo EM, Lee RR, Vilke GM. Utility of Shunt Series in the Evaluation of Ventriculoperitoneal Shunt Dysfunction in Adults. J Emerg Med 2019; 58:391-397. [PMID: 31806435 DOI: 10.1016/j.jemermed.2019.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 10/05/2019] [Accepted: 10/13/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND When patients present to emergency departments (EDs) with symptoms suspicious for ventriculoperitoneal shunt malfunction, evaluation often includes imaging of the shunt with both computed tomography (CT) of the head without contrast and a plain radiograph "shunt series" (SS). Recent literature has called into question the diagnostic value of the SS for the detection of ventriculoperitoneal shunt complications, suggesting that the plain radiographs provide redundant information and unnecessary exposure to radiation. OBJECTIVE The aim of our study was to assess the frequency of abnormal SS plain radiography and head CT in the evaluation of shunt malfunction in all adult ED patients and to measure the association of abnormalities on CT and SS with surgical intervention. METHODS We performed a retrospective chart review of all emergency department encounters at an urban level I trauma center between August 1, 2013 and October 3, 2018 in which an SS and head CT examination were performed within 24 h of each other. We described the results of imaging studies qualitatively and descriptive statistics were performed. RESULTS Positive findings on CT were significantly associated with the decision to proceed to surgery. Positive findings on SS, however, were not significantly associated with the decision to proceed to surgery. CONCLUSIONS The potential information gained from SS and convenience of ordering simultaneously with head CT does not appear to outweigh the risk of increased radiation exposure to the patient, the additional costs of the study, and the potential delay in time to head CT. These findings support the initial use of head CT in evaluation of shunt malfunction.
Collapse
Affiliation(s)
- Taylor A Docter
- School of Medicine, University of California San Diego, La Jolla, California
| | - Bhavik H Patel
- School of Medicine, University of California San Diego, La Jolla, California
| | - Jesse J Brennan
- Department of Emergency Medicine, University of California San Diego, San Diego, California
| | - Edward M Castillo
- Department of Emergency Medicine, University of California San Diego, San Diego, California
| | - Roland R Lee
- Department of Radiology, University of California San Diego, San Diego, California; Department of Radiology, VA San Diego Healthcare System, San Diego, California
| | - Gary M Vilke
- Department of Emergency Medicine, University of California San Diego, San Diego, California
| |
Collapse
|
22
|
Mathew RP, Alexander T, Patel V, Low G. Chest radiographs of cardiac devices (Part 1): Lines, tubes, non-cardiac medical devices and materials. SA J Radiol 2019; 23:1729. [PMID: 31754535 PMCID: PMC6837827 DOI: 10.4102/sajr.v23i1.1729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/05/2019] [Indexed: 11/06/2022] Open
Abstract
Chest radiographs (CXRs) are the most common imaging investigations undertaken because of their value in evaluating the cardiorespiratory system. They play a vital role in intensive care units for evaluating the critically ill. It is therefore very common for the radiologist to encounter tubes, lines, medical devices and materials on a daily basis. It is important for the interpreting radiologist not only to identify these iatrogenic objects, but also to look for their accurate placement as well as for any complications related to their placement, which may be seen either on the immediate post-procedural CXR or on a follow-up CXR. In this article, we discussed and illustrated the routinely encountered tubes and lines that one may see on a CXR as well as some of their complications. In addition, we also provide a brief overview of other important non-cardiac medical devices and materials that may be seen on CXRs.
Collapse
Affiliation(s)
- Rishi P Mathew
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Timothy Alexander
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Vimal Patel
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Gavin Low
- Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| |
Collapse
|
23
|
Gadde JA, Weinberg BD, Mullins ME. Neuroimaging of Patients in the Intensive Care Unit: Pearls and Pitfalls. Radiol Clin North Am 2019; 58:167-185. [PMID: 31731899 DOI: 10.1016/j.rcl.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A brief introduction is provided of the different imaging modalities encountered in the intensive care unit (ICU). The spectrum of intracranial pathology as well as potential postsurgical complications is reviewed, with a focus on pearls and pitfalls. A brief overview also is provided of imaging of the spine in an ICU patient.
Collapse
Affiliation(s)
- Judith A Gadde
- Department of Radiology and Imaging Services, Emory University School of Medicine, 1364 Clifton Road Northeast, Suite BG20, Atlanta, GA 30319, USA.
| | - Brent D Weinberg
- Department of Radiology and Imaging Services, Emory University School of Medicine, 1364 Clifton Road Northeast, Suite BG20, Atlanta, GA 30319, USA
| | - Mark E Mullins
- Department of Radiology and Imaging Services, Emory University School of Medicine, 1364 Clifton Road Northeast, Suite BG20, Atlanta, GA 30319, USA
| |
Collapse
|
24
|
Krishnan SR, Ray TR, Ayer AB, Ma Y, Gutruf P, Lee K, Lee JY, Wei C, Feng X, Ng B, Abecassis ZA, Murthy N, Stankiewicz I, Freudman J, Stillman J, Kim N, Young G, Goudeseune C, Ciraldo J, Tate M, Huang Y, Potts M, Rogers JA. Epidermal electronics for noninvasive, wireless, quantitative assessment of ventricular shunt function in patients with hydrocephalus. Sci Transl Med 2019; 10:10/465/eaat8437. [PMID: 30381410 DOI: 10.1126/scitranslmed.aat8437] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/11/2018] [Indexed: 12/30/2022]
Abstract
Hydrocephalus is a common and costly neurological condition caused by the overproduction and/or impaired resorption of cerebrospinal fluid (CSF). The current standard of care, ventricular catheters (shunts), is prone to failure, which can result in nonspecific symptoms such as headaches, dizziness, and nausea. Current diagnostic tools for shunt failure such as computed tomography (CT), magnetic resonance imaging (MRI), radionuclide shunt patency studies (RSPSs), and ice pack-mediated thermodilution have disadvantages including high cost, poor accuracy, inconvenience, and safety concerns. Here, we developed and tested a noninvasive, skin-mounted, wearable measurement platform that incorporates arrays of thermal sensors and actuators for precise, continuous, or intermittent measurements of flow through subdermal shunts, without the drawbacks of other methods. Systematic theoretical and experimental benchtop studies demonstrate high performance across a range of practical operating conditions. Advanced electronics designs serve as the basis of a wireless embodiment for continuous monitoring based on rechargeable batteries and data transmission using Bluetooth protocols. Clinical studies involving five patients validate the sensor's ability to detect the presence of CSF flow (P = 0.012) and further distinguish between baseline flow, diminished flow, and distal shunt failure. Last, we demonstrate processing algorithms to translate measured data into quantitative flow rate. The sensor designs, fabrication schemes, wireless architectures, and patient trials reported here represent an advance in hydrocephalus diagnostics with ability to visualize flow in a simple, user-friendly mode, accessible to the physician and patient alike.
Collapse
Affiliation(s)
- Siddharth R Krishnan
- Frederick Seitz Materials Research Laboratory, Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.,Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Tyler R Ray
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Amit B Ayer
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Yinji Ma
- AML, Department of Engineering Mechanics, Interdisciplinary Research Center for Flexible Electronics Technology, Tsinghua University, Beijing 100084, China
| | - Philipp Gutruf
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - KunHyuck Lee
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Jong Yoon Lee
- Department of Electrical and Computer Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Chen Wei
- Departments of Civil and Environmental Engineering, Mechanical Engineering, and Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Xue Feng
- AML, Department of Engineering Mechanics, Interdisciplinary Research Center for Flexible Electronics Technology, Tsinghua University, Beijing 100084, China
| | - Barry Ng
- Frederick Seitz Materials Research Laboratory, Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Zachary A Abecassis
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Nikhil Murthy
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Izabela Stankiewicz
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Juliet Freudman
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Julia Stillman
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Natalie Kim
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA
| | - Grace Young
- Frederick Seitz Materials Research Laboratory, Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Camille Goudeseune
- Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - John Ciraldo
- Northwestern University Micro/Nano Fabrication Facility (NUFAB), Northwestern University, Evanston, IL 60208, USA
| | - Matthew Tate
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Yonggang Huang
- Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA.,Departments of Civil and Environmental Engineering, Mechanical Engineering, and Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Matthew Potts
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA. .,Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - John A Rogers
- Frederick Seitz Materials Research Laboratory, Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA. .,Center for Bio-Integrated Electronics, Northwestern University, Evanston, IL 60208, USA.,Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA.,Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.,Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| |
Collapse
|
25
|
Gholampour S, Bahmani M, Shariati A. Comparing the Efficiency of Two Treatment Methods of Hydrocephalus: Shunt Implantation and Endoscopic Third Ventriculostomy. Basic Clin Neurosci 2019; 10:185-198. [PMID: 31462974 PMCID: PMC6712634 DOI: 10.32598/bcn.9.10.285] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/28/2018] [Accepted: 08/26/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction: Hydrocephalus is one of the most common diseases in children, and its treatment requires brain operation. However, the pathophysiology of the disease is very complicated and still unknown. Methods: Endoscopic Third Ventriculostomy (ETV) and Ventriculoperitoneal Shunt (VPS) implantation are among the common treatments of hydrocephalus. In this study, Cerebrospinal Fluid (CSF) hydrodynamic parameters and efficiency of the treatment methods were compared with numerical simulation and clinical follow-up of the treated patients. Results: Studies have shown that in patients under 19 years of age suffering from hydrocephalus related to a Posterior Fossa Brain Tumor (PFBT), the cumulative failure rate was 21% and 29% in ETV and VPS operation, respectively. At first, the ETV survival curve shows a sharp decrease and after two months it gets fixed while VPS curve makes a gradual decrease and reaches to a level lower than ETV curve after 5.7 months. Post-operative complications in ETV and VPS methods are 17% and 31%, respectively. In infants younger than 12 months with hydrocephalus due to congenital Aqueduct Stenosis (AS), and also in the elderly patients suffering from Normal Pressure Hydrocephalus (NPH), ETV is a better treatment option. Computer simulations show that the maximum CSF pressure is the most reliable hydrodynamic index for the evaluation of the treatment efficacy in these patients. After treatment by ETV and shunt methods, CSF pressure decreases about 9 and 5.3 times, respectively and 2.5 years after shunt implantation, this number returns to normal range. Conclusion: In infants with hydrocephalus, initial treatment by ETV was more reasonable than implanting the shunt. In adult with hydrocephalus, the initial failure in ETV occurred sooner compared to shunt therapy; however, ETV was more efficient.
Collapse
Affiliation(s)
- Seifollah Gholampour
- Department of Biomedical Engineering, Faculty of Electrical & Computer Engineering, Tehran North Branch, Islamic Azad University, Tehran, Iran
| | - Mehrnoush Bahmani
- Department of Biomedical Engineering, Faculty of Electrical & Computer Engineering, Tehran North Branch, Islamic Azad University, Tehran, Iran
| | - Azadeh Shariati
- Department of Biomedical Engineering, Faculty of Electrical & Computer Engineering, Tehran North Branch, Islamic Azad University, Tehran, Iran
| |
Collapse
|
26
|
Progressive Hydrocephalus Due to Ventriculoperitoneal Shunt Infection: Detection With FDG PET CT. Clin Nucl Med 2019; 45:e146-e147. [PMID: 31361650 DOI: 10.1097/rlu.0000000000002756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Ventriculoperitoneal shunt malfunction is common in patients after shunt surgery. Imaging is done to reveal the underlying cause and confirm the diagnosis. Shunt infection is one of the common causes of shunt malfunction. FDG PET CT is an accepted infection imaging tool and can be used to diagnose shunt infection accurately in a patient with high clinical suspicion.
Collapse
|
27
|
George MP, Kim WG, Lee EY. Tales from the Night:: Emergency MR Imaging in Pediatric Patients after Hours. Magn Reson Imaging Clin N Am 2019; 27:409-426. [PMID: 30910105 DOI: 10.1016/j.mric.2019.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Overnight in-house radiology has rapidly become an important part of contemporary practice models, and is increasingly the norm in pediatric radiology. MR imaging is an indispensable first-line and problem-solving tool in the pediatric population. This has led to increasingly complex MR imaging being performed "after hours" on pediatric patients. This article reviews the factors that have led to widespread overnight subspecialty radiology and the associated challenges for overnight radiologists, and provides an overview of up-to-date imaging techniques and imaging findings of the most common indications for emergent MR imaging in the pediatric population.
Collapse
Affiliation(s)
- Michael P George
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Wendy G Kim
- Department of Radiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Edward Y Lee
- Division of Thoracic Imaging, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 330 Longwood Avenue, Boston, MA 02115, USA
| |
Collapse
|
28
|
Shunt Devices for Neurointensivists: Complications and Management. Neurocrit Care 2018; 27:265-275. [PMID: 28243998 DOI: 10.1007/s12028-016-0366-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cerebrospinal fluid diversion has become the mainstay treatment in hydrocephalus for over 50 years. As the number of patients with ventricular shunt systems increases, neurointensivists are becoming the first-line physicians for many of these patients. When symptoms of a shunt malfunction are suspected and access to a neurosurgeon is limited or delayed, workup and temporizing measures must be initiated. The article highlights the functional nuances, complications, and management of current programmable shunt valves and their MRI sensitivity.
Collapse
|
29
|
Bermo MS, Khalatbari H, Parisi MT. Two signs indicative of successful access in nuclear medicine cerebrospinal fluid diversionary shunt studies. Pediatr Radiol 2018; 48:1130-1138. [PMID: 29737381 DOI: 10.1007/s00247-018-4150-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 03/07/2018] [Accepted: 04/25/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Successful shunt access is the first step in a properly performed nuclear medicine cerebrospinal fluid (CSF) shunt study. OBJECTIVE To determine the significance of the radiotracer configuration at the injection site during initial nuclear medicine CSF shunt imaging and the lack of early systemic radiotracer activity as predictors of successful shunt access. MATERIALS AND METHODS With Institutional Review Board approval, three nuclear medicine physicians performed a retrospective review of all consecutive CSF shunt studies performed in children at our institution in 2015. Antecedent nuclear medicine CSF shunt studies in these patients were also assessed and included in the review. The appearance of the reservoir site immediately after radiotracer injection was classified as either figure-of-eight or round/ovoid configuration. The presence or absence of early systemic distribution of the tracer on the 5-min static images was noted and separately evaluated. RESULTS A total of 98 nuclear medicine ventriculoperitoneal CSF shunt studies were evaluated. Figure-of-eight configuration was identified in 87% of studies and, when present, had 93% sensitivity, 78% specificity, 92% accuracy, 98% positive predictive value (PPV) and 54% negative predictive value (NPV) as a predictor of successful shunt access. Early systemic activity was absent in 89 of 98 studies. Lack of early systemic distribution of the radiotracer had 98% sensitivity, 78% specificity, 96% accuracy, 98% PPV and 78% NPV as a predictor of successful shunt access. Figure-of-eight configuration in conjunction with the absence of early systemic tracer activity had 99% PPV for successful shunt access. CONCLUSION Figure-of-eight configuration at the injection site or lack of early systemic radiotracer activity had moderate specificity for successful shunt access. Specificity and PPV significantly improved when both signs were combined in assessment.
Collapse
Affiliation(s)
- Mohammed S Bermo
- Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA.
| | - Hedieh Khalatbari
- Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA.,Department of Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Marguerite T Parisi
- Department of Radiology, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA.,Department of Radiology, Seattle Children's Hospital, Seattle, WA, USA.,Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| |
Collapse
|
30
|
Ventriculopleural Shunt Dysfunction Due to a Loculated Pleural Collection Demonstrated on SPECT/CT Imaging. Clin Nucl Med 2017; 43:144-146. [PMID: 29261631 DOI: 10.1097/rlu.0000000000001956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 35-year-old woman presented with increasing drowsiness on a background of childhood meningitis and hydrocephalus managed with a ventriculopleural shunt. Her cerebral CT and chest radiograph were unchanged from previous imaging and did not identify significant pathology. Because of clinical suspicion of cerebrospinal fluid shunt dysfunction, she was referred for a cerebrospinal fluid shunt study, which demonstrated tracer accumulation within a loculated pleural collection in the left costophrenic recess.
Collapse
|
31
|
Bates P, Rajderkar D. Common and Uncommon Causes of Ventriculoperitoneal Shunt Malfunction Diagnosed on Plain Radiographs. Curr Probl Diagn Radiol 2017; 47:317-323. [PMID: 28830622 DOI: 10.1067/j.cpradiol.2017.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 07/06/2017] [Accepted: 07/26/2017] [Indexed: 11/22/2022]
Abstract
Thousands of patients with hydrocephalus are treated successfully with ventriculoperitoneal shunts. Ventriculoperitoneal shunts are known to have high malfunction rates, most of which are owing to mechanical causes. When shunt malfunction is suspected, shunt series are often performed to evaluate the mechanical causes of malfunction. These initial radiographs have proven critical in guiding subsequent management. This article is designed to review the various causes of shunt malfunction that can be diagnosed with radiographs.
Collapse
Affiliation(s)
- Phillip Bates
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL
| | - Dhanashree Rajderkar
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL.
| |
Collapse
|
32
|
Kale HA, Muthukrishnan A, Hegde SV, Agarwal V. Intracranial Perishunt Catheter Fluid Collections with Edema, a Sign of Shunt Malfunction: Correlation of CT/MRI and Nuclear Medicine Findings. AJNR Am J Neuroradiol 2017; 38:1754-1757. [PMID: 28705818 DOI: 10.3174/ajnr.a5291] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 04/08/2017] [Indexed: 11/07/2022]
Abstract
Fluid collections with edema along the intracranial tract of ventriculoperitoneal shunt catheters in adults are rare and are more frequently seen in children. The imaging appearance of these fluid collections is frequently confusing and presents a diagnostic dilemma. We present 6 cases of adult patients noted to have collections with edema along the tract of ventriculoperitoneal shunt catheters. To our knowledge, there are no previous studies correlating the CT/MR imaging findings with nuclear medicine scans in this entity. We hypothesized that when seen in adults, the imaging findings of a CSF-like fluid collection around the intracranial ventriculoperitoneal shunt catheter on CT/MR imaging may suggest areas of CSF accumulation with interstitial edema. It is important to recognize this rare ventriculoperitoneal shunt complication in adults to prevent misdiagnosis of an abscess or cystic tumor.
Collapse
Affiliation(s)
- H A Kale
- From the Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - A Muthukrishnan
- From the Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - S V Hegde
- From the Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - V Agarwal
- From the Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| |
Collapse
|
33
|
Dorsett M, Liang SY. Diagnosis and Treatment of Central Nervous System Infections in the Emergency Department. Emerg Med Clin North Am 2016; 34:917-942. [PMID: 27741995 PMCID: PMC5082707 DOI: 10.1016/j.emc.2016.06.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Central nervous system (CNS) infections, including meningitis, encephalitis, and brain abscess, are rare but time-sensitive emergency department (ED) diagnoses. Patients with CNS infection can present to the ED with nonspecific signs and symptoms, including headache, fever, altered mental status, and behavioral changes. Neuroimaging and CSF fluid analysis can appear benign early in the course of disease. Delaying therapy negatively impacts outcomes, particularly with bacterial meningitis and herpes simplex virus encephalitis. Therefore, diagnosis of CNS infection requires vigilance and a high index of suspicion based on the history and physical examination, which must be confirmed with appropriate imaging and laboratory evaluation.
Collapse
Affiliation(s)
- Maia Dorsett
- Division of Emergency Medicine, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8072, St. Louis, Missouri 64110, USA
| | - Stephen Y. Liang
- Division of Emergency Medicine, Division of Infectious Diseases, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8051, St. Louis, Missouri 63110, USA
| |
Collapse
|
34
|
|
35
|
Bolster F, Fardanesh R, Morgan T, Katz DS, Daly B. Cross-sectional imaging of thoracic and abdominal complications of cerebrospinal fluid shunt catheters. Emerg Radiol 2015; 23:117-25. [PMID: 26610766 DOI: 10.1007/s10140-015-1368-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 11/17/2015] [Indexed: 10/22/2022]
Abstract
This study aims to review the imaging findings of distal (thoracic and abdominal) complications related to ventriculo-peritoneal (VP), ventriculo-pleural (VPL), and ventriculo-atrial (VA) cerebrospinal fluid (CSF) shunt catheter placement. Institution review board-approved single-center study of patients with thoracic and abdominal CSF catheter-related complications on cross-sectional imaging examinations over a 14-year period was performed. Clinical presentation, patient demographics, prior medical history, and subsequent surgical treatment were recorded. The presence or absence of CSF catheter-related infection and/or acute hydrocephalus on cross-sectional imaging was also recorded. There were 81 distal CSF catheter-related complications identified on 47 thoracic or abdominal imaging examinations in 30 patients (age 5-80 years, mean 39.3 years), most often on CT (CT = 42, MRI = 1, US = 4). Complications included 38 intraperitoneal and 11 extraperitoneal fluid collections. Extraperitoneal collections included nine abdominal wall subcutaneous (SC) pseudocysts associated with shunt migration and obesity, an intrapleural pseudocyst, and a breast pseudocyst. There were also two large VPL-related pleural effusions, a fractured catheter in the SC tissues, and a large VA shunt thrombus within the right atrium. Ten patients (33.3 %) had culture-positive infection from CSF or shunt catheter samples. Ten patients (33.3 %) had features of temporally related acute or worsening hydrocephalus on neuroimaging. In four of these patients, the detection of thoracic and abdominal complications on CT preceded and predicted the findings of acute hydrocephalus on cranial imaging. Thoracic and abdominal complications of CSF shunts, as can be identified on CT, include shunt infection and/or obstruction, may be both multiple and recurrent, and may be predictive of concurrent acute intracranial problems.
Collapse
Affiliation(s)
- Ferdia Bolster
- Department of Radiology, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD, 21201, USA.
| | - Reza Fardanesh
- Department of Radiology, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD, 21201, USA
| | - Tara Morgan
- Department of Radiology, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD, 21201, USA
| | - Douglas S Katz
- Department of Radiology, Winthrop-University Hospital, Mineola, NY, 11501, USA
| | - Barry Daly
- Department of Radiology, University of Maryland School of Medicine, 22 S Greene Street, Baltimore, MD, 21201, USA
| |
Collapse
|