Journal of the Louisiana State Medical Society
Figure 1: Immediate postoperative plain film X-ray shunt series of neck (top left) and abdomen (bottom left) showing medial course of the shunt catheter and placement in the peritoneal cavity. Staples used to close the abdominal incision are seen as well. Abdominal X-ray (bottom right) shows shunt catheter no longer located in the abdomen and lies completely supradiaphragmatic.
with negative inspiratory pressure, draws the catheter proximally through the vein and eventually to the heart or pulmonary artery. This seems themost plausiblemechanism as 10 of the 12 reported cases describe damage to a jugular vein. Of the 10, seven described passage through the internal
to a vein when using the shunt passer, with some portion of the distal catheter within the vessel. This may occur when tunneling too deep or toomedial in the supraclavicular area. After removal of the shunt passer, a portion of the catheter is left intravenous, and the orthrograde blood flow, combined
22 J La State Med Soc VOL 166 January/February 2014
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