Abstract
Background:Thoracic complications of ventriculoperitoneal (VP) shunts have been extensively reported in the literature. Cerebrospinal fluid (CSF) hydrothorax without catheter migration, however, has been rarely described and poorly understood.Case Description:We describe development of pleural effusion and respiratory distress in a 3-year-old boy with no evidence of VP shunt catheter displacement on plain radiograph and stable ventricle size on rapid sequence magnetic resonance imaging (MRI) brain. Chest X-ray revealed complete opacity of right hemithorax. Pleural effusion was consistent with transudate. Beta-2 transferrin returned positive. The patient underwent externalization of VP shunt, and upon resolution of effusion, re-internalization with new distal shunt catheter. A literature review of CSF hydrothorax in children without intrathoracic shunt migration was performed. Eleven cases were identified in the English literature. Age at VP shunt placement ranged from birth to 8 years of age. Interval from VP shunt placement to CSF hydrothorax ranged from 1.5 months to 5 years. History of shunt revision was reported in two cases. Presenting symptoms also included ascites and inguinal hernia or hydrocele. Reported diagnostic studies consist of CSF culture, radionuclide shuntogram, beta-2 transferrin, and beta-trace protein. Laterality of the VP shunt and development of pleural effusion were predominantly right sided. Definitive surgical treatment included VA shunt, repositioning of the peritoneal catheter, and endoscopic choroid plexus coagulation.Conclusion:CSF hydrothorax is a rare thoracic complication of VP shunt placement with no radiographic evidence of shunt migration or malfunction. Postulated mechanisms include limited peritoneal capacity to resorb CSF in children and microscopic communications present in congenital diaphragmatic hiatuses.
Highlights
Thoracic complications of ventriculoperitoneal (VP) shunts have been extensively reported in the literature
We report a case of Cerebrospinal fluid (CSF) hydrothorax in a child with no radiographic evidence of VP shunt migration and review the literature on associated clinical findings
Serial ultrasound exam demonstrated no re‐accumulation of pleural fluid, and the chest tube was subsequently removed
Summary
CSF hydrothorax is a rare thoracic complication of VP shunt placement with no radiographic evidence of shunt migration or malfunction. Cerebrospinal fluid (CSF) pleural effusion in the absence of migration of distal VP shunt catheter in SNI: Pediatric Neurosurgery 2015, Vol 6: Suppl 11 - A Supplement to Surgical Neurology International children, has been rarely described and poorly understood.[11] We report a case of CSF hydrothorax in a child with no radiographic evidence of VP shunt migration and review the literature on associated clinical findings. The patient is a 3‐year‐old boy born at 40 weeks by Cesarean section who initially presented with congenital hydrocephalus He had right VP shunt placement at birth, with subsequent revisions at 13 and 23 months of age. Patient’s co‐morbidities include intractable epilepsy and craniosynostosis On examination, he was somnolent, but he would open his eyes spontaneously. Serial ultrasound exam demonstrated no re‐accumulation of pleural fluid, and the chest tube was subsequently removed. At 1 year follow‐up, he has no re‐accumulation of pleural fluid, and no signs or symptoms of shunt malfunction
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