Worsening respiratory failure in an adult hydrocephalic patient with a ventriculo-pleural shunt.

Samuel Wreghitt,Hari Wimaleswaran,Vishnu Jeganathan,Edmond Wong,Mark E Howard,Gavin Davis

doi:10.1002/rcr2.660

Abstract

Ventriculo‐pleural (VPL) shunt insertion is performed in hydrocephalic patients when alternative sites of cerebrospinal fluid (CSF) diversion are contraindicated. These include patients with peritoneal complications from ventriculo‐peritoneal shunts. Despite its utility, VPL shunts are uncommon. Hydrothoraces should be considered as a potential cause of dyspnoea in the setting of a VPL shunt. We present a case of worsening respiratory failure in the setting of a massive CSF hydrothorax in a hydrocephalic patient with a VPL shunt to highlight this potential complication of pleural CSF diversion, and present a potential management strategy in patients with premorbid underlying lung pathology. In this case, the hydrothorax was drained and the shunt was converted to ventriculo‐atrial (VA) shunt.

Highlights

Ventriculo-peritoneal (VP) shunt insertion is commonly performed in the management of communicating hydrocephalus, mitigating the risk of rising intracranial pressure and cerebral herniation through diversion of cerebrospinal fluid (CSF) to the peritoneal cavity [1]
We present a case of an adult hydrocephalic patient with a VPL shunt in situ presenting with worsening respiratory failure in the setting of a massive CSF hydrothorax
A 44-year-old female was referred after a telehealth conference with a six-month history of worsening dyspnoea, orthopnoea, and increasing non-invasive ventilation (NIV) dependence

Summary

Introduction

Ventriculo-peritoneal (VP) shunt insertion is commonly performed in the management of communicating hydrocephalus, mitigating the risk of rising intracranial pressure and cerebral herniation through diversion of cerebrospinal fluid (CSF) to the peritoneal cavity [1]. VP shunts have reported failure rates between 30% and 50% over two years [2,3]. We present a case of an adult hydrocephalic patient with a VPL shunt in situ presenting with worsening respiratory failure in the setting of a massive CSF hydrothorax. Her surgical history included a ventriculo-atrial (VA) shunt inserted at age two years for hydrocephalus of unclear aetiology.

Results

Conclusion