The patient proceeded to thoracic surgery for removal of the migrated VP shunt. The VP shunt was determined to have somehow entered the IJV (the mechanism is not completely known, as previous imaging had shown the VP shunt was appropriately positioned). The VP shunt then traveled via the following pathway (correlating the CT imaging with the coronary angiogram):
- SVC → right atrium → right ventricle → pulmonary trunk bifurcation → looped back on itself back into the right ventricle → right atrium → presumably through a PFO or ASD into a left upper lobe pulmonary vein