Delayed adult-onset recurrent symptomatic pleural effusion secondary to ventriculopleural shunt

Abstract

Extracranial shunts alleviate symptoms in patients with hydrocephalus by diverting cerebrospinal fluid (CSF) to an extravascular compartment. The most common procedure is ventriculoperitoneal shunting (VPS). However, certain patients with multiple shunt revisions, morbid obesity, or a history of abdominal surgeries may not be suitable VPS candidates; ventriculopleural shunting (VPLS) may be considered as an alternative route for CSF diversion when the peritoneal cavity is unsuitable. Pleural effusions, shunt obstruction, pneumothorax, and empyema can complicate the course of these shunts, though they are infrequent. Most reports of pleural effusions have been in young adults and children, particularly within three years of placement. We report the case of a 36-year-old female who presented with recurrent symptomatic pleural effusion. The onset of symptoms was more than 25 years since insertion of VPLS. Initially managed with multiple therapeutic thoracentesis. Eventually patient underwent revision of shunt to VPS leading to resolution of symptoms.