Intracardiac VP shunt migration

Case contributed by Dr Zach Drew

Presentation

Presenting with chest pain. ?PE. CTPA ordered. Background of a VP shunt insertion for SAH.

Patient Data

Age: 60
Gender: Female
CT

CTPA

Migrated VP shunt was missed on this study. Patient proceeded to a coronary angiogram for further work-up of chest pain.

DSA (angiography)

Coronary angiogram

The patient's coronary angiogram showed normal coronary arteries and preserved LV systolic function. However, the migrated, intra-cardiac VP shunt was detected and correlated with the prior CTPA. A non contrast CT Chest was ordered to further define position.

CT

Non Contrast CT

Non Contrast CT Chest to define position of the migrate VP shunt. Study shows the catheter within the superior vena cava, entering the superior vena cava in the supraclavicular fossa. It then appears to loop within the heart, with the tip sitting in a left pulmonary vein.

Case Discussion

The patient proceeded to thoracic surgery for removal of the migrated VP shunt. The VP shunt was determined to have somehow entered the IJV (mechanism 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 study): 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.

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Case information

rID: 67928
Published: 20th May 2019
Last edited: 20th May 2019
Inclusion in quiz mode: Excluded

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