Cerebrospinal Fluid Hydrothorax without Ventriculoperitoneal Shunt Migration in an Infant

Abstract

Cerebrospinal fluid (CSF) hydrothorax is a rare complication of a ventriculoperitoneal shunt (VPS), and even rarer in the absence of shunt migration into the thoracic compartment. Because of the limited volume within the thoracic cavity, hydrothorax in infants can rapidly cause severe respiratory distress. The case of an infant with recurrent CSF hydrothorax despite a well-positioned VPS is presented. A ventriculoatrial shunt was successfully performed as the definitive treatment. The absence of ascites or predisposing factors for decreased peritoneal absorption and a false-negative β₂-transferrin CSF marker are some of the factors that can add to the diagnostic challenge in these patients. This is a potentially life-threatening condition in infants, which should be closely considered in patients with VPS who develop hydrothorax, although diagnosis is not always straight forward. The etiology and pathophysiology of this very rare disease continue to be elusive, and treatment with ventriculoatrial shunt provides good results.

Pleural effusion and respiratory compromise from spontaneous migration of a ventriculoperitoneal shunt catheter in a patient with normal-pressure hydrocephalus

“…[ 9 , 12 ] Infections causing malfunctions account for approximately 5–15%. [ 6 ] Pleural effusions due to VPS are rare, occurring mainly in children,[ 1 , 4 , 13 , 19 , 21 - 24 ] and with 60% of all pleural effusions being associated with the distal catheter migration into the thorax.…”

A rare complication of ventriculoperitoneal shunt: Pleural effusion without intrathoracic ventriculoperitoneal shunt catheter

“…[ 10 , 12 , 13 ] Furthermore, authors hypothesize that local inflammatory reactions or repeated microtrauma induced by the shunt tip may contribute to the diaphragm erosion facilitating CSF effusion, as showed in our patient. [ 14 , 20 ] The negative intrathoracic pressure and the positive intra-abdominal pressure contribute to the fluid shift. [ 15 ]…”

Pleural effusion in a child with a ventriculoperitoneal shunt and congenital heart disease

“…Pleural effusions secondary to CSF extravasation in the setting of VP shunts can occur by one of three mechanisms: (1) intrathoracic trauma during shunt placement; (2) migration of the peritoneal catheter into the thoracic cavity; (3) pleural effusion secondary to increased intraabdominal pressure due to CSF ascites (Taub and Lavyne 1994 ). Ours is the 38th reported case of CSF pleural effusion (Obrador and Villarejo 1977 ; Cooper 1978 ; Agha et al 1983 ; Lourie and Bajwa 1985 ; Anegawa et al 1986 ; Gaudio et al 1988 ; Dickman et al 1989 ; Savolaine and Khimji 1991 ; Meeker and Barnett 1994 ; Gupta and Berry 1994 ; Doh et al 1995 ; Johnson and Maxwell 1995 ; Martin et al 1997 ; Mayoralas Alises et al 1999 ; Di Roio and Mottolese 2000 ; Akyuz et al 2004 ; Samdani et al 2005 ; Rahimi Rad et al 2007 ; Kim et al 2008 ; Ergun et al 2008 ; Kiran et al 2010 ; Glatstein et al 2012 ; Globl 1978 ; Ceccotti et al 1981 ; Trappe et al 1988 ; Faillace and Garrison 1998 ; Hadzikaric et al 2002 ; Muramatsu and Koike 2004 ; Adeolu et al 2006 ; Born et al 2008 ; Smith and Cohen 2009 ; Kocaogullar et al 2011 ; Patel et al 2011 ; Chuen-im et al 2012 ; Ulus et al 2012 ; Sekiguchi et al 2013 ). A majority of these cases (58 %) were due to peritoneal catheter migration into the thorax.…”