Migration of Tc-99m DTPA from the cerebral ventricle to the subarachnoid space

A 70-year-old woman was examined because of increasing problems with cognition. She had a history of a cerebral shunt placed surgically 10 years previously. Introduction of Tc-99m DTPA directly into the ventricular cavity revealed good ventricular distribution, followed by progression downward, as though into a previous ventriculoperitoneal shunt. However, a chest radiograph revealed what appeared to be a shunt tube in the right atrium. Delayed lateral images showed activity in proximity to the vertebral column, indicating migration of tracer and cerebrospinal fluid into the dorsal and lumbar subarachnoid space.