Chest x-ray demonstrates a rounded opacity projecting from the right cardiomediastinal border, closely related to a catheter tip, which can be traced as far as the superior edge of the film (?CVC ?VA shunt). The hilum can be seen through it (hilum overlay sign) and the SVC outline is lost suggesting the mass is in the anterior mediastinum. The lungs and pleural spaces are unremarkable.
Low density anterior mediastinal mass measuring 46 x 49 x 50mm is adjacent to the right atrium and may be pericardial in origin. The ventricular shunt tip is seen at its lateral aspect. No enlarged axillary, mediastinal or hilar lymph nodes. The density of this cyst is only 26HU.
Conclusion: Right anterior mediastinal low density mass, adjacent to the right atrium may be pericardial in origin. ventriculoatrial (VA) shunt tip passes into this mass. This presumably represent proximal migration of the shunt tip with the development of CSF cyst.
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