Pleural cerebrospinal fluid shunting causing trapped lung: A respiratory physician's approach to management and prevention

Abstract

Cerebrospinal fluid (CSF) shunting into the pleural space can cause complications such as long-standing pleural effusions and trapped lung. These complications can be difficult to manage due to the propensity of effusions to recur, and the irreversible nature of trapped lung. This report describes the case of a woman with a pleural CSF shunt who developed chronic pleural effusions and trapped lung over two years, following a 24-year period without any respiratory shunt complications. Management options for this patient included thoracentesis, lung decortication, insertion of an indwelling pleural catheter, and shunt revision. Advocating for pleural shunt revision when symptomatic or increasingly large pleural effusions occur may prevent the development of trapped lung.

Shunt-Bronchial Fistula with Coughing Up and Swallowing of Cerebrospinal Fluid: Rare Complication of Ventriculopleural Shunt

“…Ventriculoatrial shunting may be complicated by migration into the pericardium to cause cardiac tamponade or into the pulmonary system to create a bronchovenous fistula as late as 5 years after initial shunt implantation 21 , 22 . With regard to ventriculopleural shunts, complications described include pleural effusion, pneumothorax, hydrothorax, intrapleural pseudocysts, cardiac tamponade with heart failure, respiratory failure, or trapped lung 23, 24, 25, 26, 27, 28, 29, 30, 31, 32. A case report from 1962 described a patient with a ventriculopleural shunt who presented with severe headache in addition to long-standing irritating and constant desire to cough for several weeks.…”

Trapped lung: a review of literature and recent cases

“…The Southwest Respiratory and Critical Care Chronicles 2023;11(46):[25][26][27][28][29][30][31][32][33] The Southwest Respiratory and Critical Care Chronicles 2023;11(46):[25][26][27][28][29][30][31][32][33] …”