Pediatric Ventriculoperitoneal Shunt Malfunction / Malposition / Misposition / Misplacement

  • Etiology: placed in patients who require long-term decompression of hydrocephalus
  • Imaging: superior catheter tip should be intraventricular in location, inferior catheter tip should be freely floating within the peritoneum, normal to see small amount of free fluid in pelvis, ventricles should not be dilated
  • Complications: shunt broken or discontinuous or kinked or occluded, shunt tip migration out of ventricle, shunt tip intraparenchymal, shunt infection, over-shunting (slit-like ventricles), CSFoma
  • Treatment: shunt replacement except in cases of shunt infection which require temporary shunt diversion before shunt replacement
  • Clinical: presents with headaches / sommulence / irritability, shunt infection presents with fever, CSFoma presents with abdominal mass

Radiology Cases of Ventriculoperitoneal Shunt Malfunction / Malposition / Misposition / Misplacement

Radiology Cases of Ventriculoperitoneal Shunt Broken

Radiograph of ventriculoperitoneal shunt malfunction
AP and lateral radiographs of the abdomen shows the distal portion of the VP shunt to be broken into multiple fragments.

Radiology Cases of Ventriculoperitoneal Shunt Discontinuity

Radiograph and CT of ventriculoperitoneal shunt malfunction
AP radiograph of the skull shows a discontinuity between the tip of the VP shunt and the rest of the VP shunt. Axial, coronal, and sagittal CT without contrast of the brain shows marked hydrocephalus with transependymal flow of cerebrospinal fluid.
Radiograph of ventriculoperitoneal shunt malfunction
AP and lateral radiographs of the skull and an AP radiograph of the abdomen shows a discontinuity between the reservoir of the VP shunt in the neck and the remainder of the VP shunt in the abdomen.

Radiology Cases of Ventriculoperitoneal Shunt Kinked

Radiograph of ventriculoperitoneal shunt malfunction
AP and lateral radiographs of the skull show a kink in the VP shunt in the middle of the neck.

Radiology Cases of Ventriculoperitoneal Shunt Tip Migration Out of Ventricle

Radiograph of ventriculoperitoneal shunt malfunction
AP and lateral radiographs of the skull shows migration of the VP shunt catheter tip out of its right-sided burr hole in the skull.

Radiology Cases of Ventriculoperitoneal Shunt Tip Migration Into Scrotum

AXR and US of ventriculoperitoneal shunt tip in the scrotum
AXR (above) shows the tip of the VP shunt has migrated into the right scrotum. Transverse US image (below) shows a moderate left hydrocele and the round VP shunt catheter in the medial aspect of the right scrotum.

Radiology Cases of Ventriculoperitoneal Shunt Tip Intraparenchymal

CT of ventriculoperitoneal shunt malfunction
Axial CT without contrast of the brain obtained postoperatively shows a VP shunt catheter placed from a right parietal approach whose tip lies within the brain parenchyma.

Radiology Cases of Ventriculoperitoneal Shunt Occluded

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.

Radiology Cases of Ventriculoperitoneal Shunt Infected

CT of abscess around a ventriculoperitoneal shunt
Axial CT without contrast of the brain shows a low density fluid collection around the VP shunt reservoir between the skull and the scalp. In the operating room this fluid was found to be pus.
CT of ventriculitis
Axial CT with contrast of the brain shows subependymal enhancement throughout the ventricular system.

Radiology Cases of Ventriculoperitoneal Shunt CSFoma

Radiograph and ultrasound of CSFoma
AP and lateral radiographs of the abdomen show the VP shunt to be coiled upon itself and there is a suggestion of a retrogastric mass on the lateral view. Transverse US of the left upper quadrant of the abdomen shows a large cystic structure with the VP shunt tip within it.
CT of CSFoma
Axial CT with intravenous and oral contrast of the abdomen shows an extremely large mass filling the abdomen with the tip of the VP shunt within it which is causing hydronephrosis and displacement of the bowel.

Radiology Cases of Ventriculoperitoneal Shunt Overshunting

CT of overshunting
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.