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Right pleural effusion due to a migrating ventriculoperitoneal shunt
1Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, OH 44195.
Cleveland Clinic Journal of Medicine
|March 1, 1994
Summary
A rare complication of ventriculoperitoneal shunts in pregnancy involves shunt migration to the pleural space, causing respiratory distress. Prompt thoracentesis and postpartum shunt revision are recommended management strategies.
Area of Science:
- Neurology
- Neurosurgery
- Obstetrics
Background:
- Pseudotumor cerebri (idiopathic intracranial hypertension) involves elevated intracranial pressure and papilledema.
- Treatment for pseudotumor cerebri may include diuretics or cerebrospinal fluid shunting procedures.
- Ventriculoperitoneal shunts are used to manage increased intracranial pressure.
Observation:
- A pregnant patient with pseudotumor cerebri and a ventriculoperitoneal shunt developed dyspnea.
- Chest imaging revealed a right pleural effusion with the shunt catheter misplaced in the pleural space.
- The patient required multiple thoracenteses for fluid drainage.
Findings:
- Ventriculoperitoneal shunt migration from the peritoneum to the pleural space is a potential complication.
- Pleural effusion secondary to shunt migration can cause significant respiratory compromise.
- Pregnancy may be a factor in shunt migration or presentation of symptoms.
Implications:
- Physicians must consider shunt complications in pregnant patients presenting with respiratory symptoms.
- Serial thoracenteses can serve as a temporizing measure for pleural effusions.
- Postpartum elective surgical revision of the shunt is the definitive treatment for migration.