We examined the yield and utility of shunt series (SS) performed for suspected shunt malfunction and whether an abnormal SS lead to shunt revision when head computed tomography (CT) was normal or unchanged. We reviewed medical records for all adult emergency patients over a 34-month period with suspected shunt malfunction imaged with both SS and head CT to determine whether a shunt revision was performed contemporaneous with imaging. Nine (3.4%) abnormal SS were identified among 263 studies performed. Among the 192 cases in which CT was normal or unchanged, two patients with abnormal SS underwent contemporaneous shunt revision. Yield of SS is very low, and in the presence of a normal or unchanged head CT, SS provides the imaging basis for contemporaneous shunt revision in 1% (2/192) of cases.