title: Intraventricular Bone Wax as Cause of Recurrent Cerebrospinal Fluid Infection: A Neuroradiologic Pitfall.
abstract: BACKGROUND
  Persistent or recurrent shunt infections can be secondary to predisposing factors, such as isolated compartments, cerebrospinal fluid leaks, or foreign bodies.
  
  
  METHODS
  A 5-year-old girl experienced several episodes of shunt infections. After careful reevaluation of all neuroradiologic records of the patient, a foreign body in the left frontal horn of the lateral ventricle was suspected. An endoscopic approach was used to identify and remove a small fragment of bone wax.
  
  
  CONCLUSIONS
  To our knowledge, this is the first report of intraventricular bone wax causing persistent CSF infection. The diagnosis was difficult because wax resembles air on computed tomography and on magnetic resonance imaging, and so it had been not noticed for months. Only its persistence on several images raised the suspicion of foreign body inside the ventricular system.
authors.affiliation: Department of Neurosurgery, Santobono-Pausilipon Pediatric Hospital, Naples, Italy. Electronic address: pierospen@gmail.com.
authors.forename: Pietro
authors.initials: P
authors.lastname: Spennato
authors.affiliation: Department of Neurosurgery, Central Military Hospital of Mexico, Mexico City, Mexico.
authors.forename: Inti Enrique
authors.initials: IE
authors.lastname: Escamilla-Rodrìguez
authors.affiliation: Department of Neurosurgery, Santobono-Pausilipon Pediatric Hospital, Naples, Italy.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Di Martino
authors.affiliation: Department of Neurosurgery, Federico II Universital Hospital, Naples, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Imperato
authors.affiliation: Department of Neurosurgery, Santobono-Pausilipon Pediatric Hospital, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mirone
authors.affiliation: Department of Neurosurgery, Santobono-Pausilipon Pediatric Hospital, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cinalli
mesh_terms: D002555:Cerebrospinal Fluid / Q000166:cytology / Q000382:microbiology*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005549:Foreign-Body Reaction / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D006801:Humans; D000069544:Infectious Encephalitis / Q000175:diagnosis* / Q000209:etiology / Q000382:microbiology; D059906:Neuroimaging / Q000379:methods; D010168:Palmitates / Q000009:adverse effects*; D012008:Recurrence; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000209:etiology*; D014885:Waxes / Q000009:adverse effects*
chemical_list: D010168:Palmitates; D014885:Waxes; C055480:bone wax
keywords: Bone wax; CSF shunt infection; Choroid plexus coagulation; Endoscopic third ventriculostomy; Foreign body; Misdiagnosis