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Ventriculitis: on a background of congenital hydrocephalus

Case contributed by Mahmoud Yacout Alabd
Diagnosis certain

Presentation

Congenital hydrocephalus managed by ventriculo-peritoneal shunt, with recent onset persistent fever.

Patient Data

Age: 4 months
Gender: Female

Diffuse marked supratentorial hydrocephalus with smooth enhancement of the epindymal lining of both lateral ventricles together with small dependent fluid-fluid leveling at both lateral ventricles posteriorly accompanied by small septum at the left side, findings suggestive of intraventricular inflamatory process with ependymitis. 

Ventriculo-peritoneal shunt catheter tip is seen at the right lateral ventricle.

Diffuse secondary parenchymal thinning and atrophy, still with no evidence of periventricular CSF permeation.

There is deficient mid line structures with communicating lateral ventricles, likely due to agenesisof the corpus callosum.

Case Discussion

Secondary ventriculitis as a complication of ventriculo-peritoneal shunt with typical findings of smooth enhancement of the ventricular lining with intraventricular fluid-fluid leveling, likely denoting pus. CSF sample was obtained for analysis and the diagnosis was conformed.

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