SHM Converge Scientific Abstract ePoster Gallery-Recurrent Symptomatic Pleural Effusion Secondary to Ventriculopleural Shunt

Pdf Summary

This case report describes a 36-year-old woman with recurrent left pleural effusions caused by a ventriculopleural shunt (VPLS), a less common alternative to ventriculoperitoneal shunting used when the abdomen is unsuitable for cerebrospinal fluid diversion. She had initially been treated repeatedly for presumed aspiration pneumonia because of cough, shortness of breath, stroke history, and choking episodes. However, her pleural fluid was transudative and symptoms improved after thoracentesis, suggesting another cause.<br /><br />After multiple recurrences over the course of a year, a chest X-ray incidentally revealed shunt tubing in the left hemithorax. Further history from her mother confirmed that the patient had hydrocephalus treated in childhood with multiple intracranial surgeries and, after abdominal shunt complications, a VPLS had been placed more than 25 years earlier. Because prior records were unavailable and the shunt had not been recognized on earlier imaging, the diagnosis was delayed.<br /><br />Neurosurgery initially felt the shunt was functioning because imaging showed only a small stable effusion and slit-like ventricles. When the patient later returned again with symptomatic pleural effusion, she underwent repeat therapeutic thoracentesis and was started on acetazolamide to reduce CSF production. Ultimately, definitive management required surgical revision from VPLS back to a ventriculoperitoneal shunt. After revision, her pleural effusion resolved and she remained asymptomatic on follow-up.<br /><br />The report highlights that pleural effusion is a known but uncommon complication of VPLS, sometimes appearing years after placement. Effusions are often transudative and may be due to impaired pleural absorption or excess CSF drainage. Clinicians should consider shunt-related pleural effusion in patients with recurrent unexplained hydrothorax, even long after shunt placement.

Asset Subtitle

Liz J. Thaliath

Meta Tag

Author List Geethu Jnaneswaran, Joseph Edmund, Liz J. Thaliath, Nicole Krolak

Category Clinical Vignettes

Concept Ventriculopleural Shunt

Concept Pleural Effusion

Concept Cerebrospinal Fluid Diversion

Concept Ventriculoperitoneal Shunt

Concept Pleural Fluid Analysis

Distinguished Non-Finalist

Presenter Organization Marshfield Clinic

Presenting Author Liz J. Thaliath

Track Adult

Keywords

ventriculopleural shunt

pleural effusion

hydrocephalus

transudative effusion

thoracentesis

cerebrospinal fluid diversion

shunt complication

ventriculoperitoneal shunt revision

hydrothorax

acetazolamide

Ventriculopleural Shunt

Pleural Effusion

Cerebrospinal Fluid Diversion

Ventriculoperitoneal Shunt

Pleural Fluid Analysis