School ager who presents with back pain after having a central venous catheter replaced 5 months ago

CXR and CT of embolized central venous catheter fragment
CXR AP shows the tip of the new catheter to be in appropriate location in the superior vena cava. There is a catheter fragment in the right lower lobe along with a large right pleural effusion. Axial CT with contrast of the chest shows the embolized catheter fragment in the periphery of the right lower lobe and to have eroded into the right pleural space, with an associated pleural effusion and atelectasis.

The diagnosis was an embolized catheter fragment after catheter removal.

Newborn with a prenatal diagnosis of hydrocephalus, status post VP shunt placement

CT of over-shunting
Initial axial CT without contrast of the brain (above) showed marked dilation of the lateral, third and fourth ventricles. Axial CT without contrast of the brain 1 day after shunt placement (below) shows interval decompression of the ventricular system and interval development of large bilateral subdural hygromas.

The diagnosis was subdural hygroma development due to over-shunting.

Toddler who is fussy and crying

CT of ventriculoperitoneal shunt malfunction
Axial T2 MRI without contrast of the brain (above) obtained 2 months ago shows normal ventricular size with a VP shunt in place. Axial CT without contrast of the brain (below) shows interval marked dilation of the lateral and third ventricles with transependymal flow of cerebrospinal fluid. The VP shunt series showed no radiographic abnormality of the VP shunt.

The diagnosis was VP shunt malfunction due to occlusion of the VP shunt.

School ager with a catheter that infuses but does not draw back

Line study of a thrombus on a central venous catheter
Scout image from a line study (above) shows migration of the tip of the catheter 90 degrees so that it now lies flush against the anterior wall of the superior vena cava. AP and lateral views from the line study after contrast injection shows staining of a long thin object resembling thrombus hanging off the tip of the catheter.

The diagnosis was thrombus of the catheter tip and occlusion of the catheter tip due to catheter migration.