Affiliations: Department of Pediatric Neurosurgery, St. Louis
Children's Hospital, Washington University, St. Louis, MS, USA | Department of Pediatric Neurosurgery, Children's
Hospital of Alabama, Birmingham, Alabama, USA
Note: [] Correspondence: R. Shane Tubbs, PhD, Pediatric Neurosurgery,
Children's Hospital of Alabama, 1600 7th Ave South ACC 400, Birmingham, AL
35233, USA. Tel.: +1 205 9399914; Fax: +1 205 9399972; E-mail: rstubbs@uab.edu
Abstract: 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.
