Differential diagnosis of pediatric ventriculoperitoneal shunt malfunction

• Shunt broken
• Shunt discontinuity
• Shunt kinked
• Shunt tip migration out of ventricle
• Shunt tip intraparenchymal
• Shunt occluded
• Shunt infected
• CSFoma
• Over-shunting

Approach to the differential diagnosis of ventriculoperitoneal shunt malfunction:

• Look at shunt series to determine if
  — Shunt is broken, discontinuous, kinked or tip has migrated out of ventricle
• If shunt is radiographically normal and neuroimaging shows ventricular dilation with shunt tip in ventricular system
  — Assume shunt is occluded
• If shunt infection suspected use neuroimaging to look for
  — Ventriculitis, meningitis, fluid around shunt reservoir
• If neuroimaging shows ventricles are slit-like
  — Consider over-shunting
• If abdominal symptoms are present
  — CSFoma should be searched for