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Review
. 2018 Mar 27;44(1):42.
doi: 10.1186/s13052-018-0480-2.

Pleural effusion from intrathoracic migration of a ventriculo-peritoneal shunt catheter: pediatric case report and review of the literature

Federica Porcaro  1 , Emidio Procaccini  2 , Maria Giovanna Paglietti  3 , Alessandra Schiavino  3 , Francesca Petreschi  3 , Renato Cutrera  3
Affiliations
Review

Pleural effusion from intrathoracic migration of a ventriculo-peritoneal shunt catheter: pediatric case report and review of the literature

Federica Porcaro et al. Ital J Pediatr. .

Abstract

Background: Pleural effusion is a rare complication of ventriculo-peritoneal (VP) cerebrospinal fluid (CSF) shunting and its diagnosis is difficult in patients with neurological and consciousness impairment.

Case report: Herein we report the case of a child affected by Pfeiffer syndrome and hydrocephalus, shunted at the age of 3 months, who developed acute respiratory failure due to a right-sided pleural effusion 2 years later. Plain chest radiographs and computed tomography (CT) showed the intrathoracic migration of the right VP shunt abdominal tip. Beta-2 transferrin, a marker for CSF, was found in the pleural fluid and the hypothesis of a CSF hydrothorax was confirmed. Effusion was treated with a thoracentesis. Seven days after, the right VP shunt was revised; a ventriculo-atrial (VA) shunt was also placed on the left side to serve as the main CSF shunt and to prevent the recurrence of hydrothorax. We review the pediatric cases of CSF hydrothorax reported in the literature and discuss the mechanisms underlying this complication together with the possible treatments.

Conclusion: Pleural effusion due to VP shunt insertion is a rare and potentially life-threatening condition that should be suspected in any patient with a VP shunt and respiratory failure. Signs of hydrothorax may moreover represent the only clinical evidence of a shunt-related complication in case of neurologically severely compromised patients in which neurologic examination cannot help to make a diagnosis.

Keywords: Children; Hydrocephalus; Pleural effusion; Ventriculoperitoneal shunt.

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Not applicable. No ethical approval is required.

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Written consent was available.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Sagittal MR image shows marked ventricular dilatation in our patient affected by Pfeiffer syndrome
Fig. 2
Fig. 2
a Coronal plane of chest and abdomen CT scan demonstrating the dislocation of the distal end of VP shunt situated over the diaphragmatic cupola and within the pleural cavity. b Abdomen CT scan 3D reconstructions
Fig. 3
Fig. 3
Factors contributing to CSF hydrothorax with or without intrathoracic VP migration
See this image and copyright information in PMC

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