Pediatric emergency medicine trisk 4650 4650
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If the history and physical examination of the ill child with a CSF shunt
suggests a possible shunt malfunction, further evaluation includes urgent
neuroimaging with either noncontrast computed tomographic (CT) scan or MRI,
with comparison to the most recent prior study, if available. Some MRIs may
miss the location of the shunt tip, and will likely reset a programmable shunt, so
one should have access to a programming magnet if MRI is used in a patient with
this type of device. The choice of imaging is based on institutional preference and
techniques used. Ultra low-dose helical CT protocols can be used to lower the
radiation risk to the patient, and scout lateral radiographs that include entire neck
to clavicles can reduce the need for plain radiographs or “shunt series,” which is
most helpful in assessing the integrity of the shunt connection and in identifying
the components of the working system. A formal shunt series radiograph study
should also be considered if there is localized swelling or pain along the shunt
tubing, distal erosions (rare) with shunt tubing present outside the body, or at
request of neurosurgery team to assist with shunt revision. Abdominal ultrasound
can help evaluate for pseudocyst in patients with abdominal symptoms,
particularly in those patients who may have an unreliable abdominal examination
due to sensory deficit or neurologic disease.
