Potential association of malignancy and repeat diagnostic CT in children with ventriculoperitoneal shunts: Report of two cases

We present two clinical cases of infants with hydrocephalus requiring multiple cerebrospinal fluid (CSF) shunt revisions and diagnostic computerized tomography (CT) scans that developed head and neck malignancies during their late teen years. These represent the first reported cases of possible diagnostic imaging-induced malignancy in children. The first patient had undergone at least 23 CT scans and 25 plain skull radiographs prior to the diagnosis of a neck Hodgkin's lymphoma. The second patient had undergone at least 14 CT scans and 15 plain skull radiographs prior to the diagnosis of a left parietal poorly differentiated gliosarcoma. Although it is not possible to prove that the multiple diagnostic studies these patients underwent caused their malignancies, these illustrative cases and the epidemiological literature describing malignancy risk and radiation exposure should give clinicians pause when considering requesting multiple diagnostic CT studies in children during the evaluation of possible CSF shunt dysfunction and other clinical problems. "Shunt magnetic resonance imaging" protocols should be considered for these patients and used whenever possible to minimize exposure to ionizing radiation.