Recurrent pleural effusion due to migration of the ventriculoperitoneal shunt catheter: A rare complication

Abstract

Introduction: Hydrocephalus is a common brain disorder in the pediatric population. Shunting cerebrospinal fluid (CSF) is the classic treatment, although it is not without complications. Several sites have been identified where the shunt system can migrate, including the pleura.

Objective: To describe a rare pediatric case of recurrent pleural effusion resulting from erratic migration of the shunt system.

Case presentation: A four-year-old male patient with a history of communicating hydrocephalus from the neonatal period underwent ventriculoperitoneal shunting (VPS) at four months of age. He visited the emergency department several times due to massive pleural effusion and underwent drainage punctures, but his condition did not improve. Upon admission, the pediatric intensive care unit evaluated him because he presented with respiratory compromise and deterioration of the pediatric assessment triangle in the respiratory category. A minimal lower pleurotomy was performed and the VPS catheter, which was located in the pleura, was visualized. This was corroborated by a chest computed tomography (CT) scan. The patient was successfully treated by diverting the system externally, treating the lung infection, and subsequently repositioning the catheter distal to the peritoneum. He was discharged with satisfactory progress.

Conclusions: Pleural migration of the shunt system is an uncommon occurrence in the pediatric population. Clinicians should suspect this condition in cases of recurrent effusion, as timely diagnosis and effective treatment ensure patient recovery.