Hydrothorax after ventriculoperitoneal shunt placement in a premature infant: an iatrogenic postoperative...

The authors describe the case of a prematurely born infant who developed hydrothorax after ventriculoperitoneal (VP) shunt placement for treatment of posthemorrhagic communicating hydrocephalus. Prior to shunt placement a bout of necrotizing enterocolitis created intense abdominal and peritoneal scarring. The authors postulate that the scarring created poor peritoneal absorption capacity of cerebrospinal fluid (CSF), with preferential flow of CSF from the peritoneal to the pleural cavity. A (99m)Tc-diethylenetriamine pentaacetic acid radionucleotide study enabled the authors to rule out shunt malfunction, and preferential transdiaphragmatic flow of CSF from the abdomen to the thoracic cavity was demonstrated. The hydrothorax resolved after conversion of the VP shunt to a ventriculoatrial shunt. Respiratory distress after VP shunt placement should be considered an unusual but important sentinel symptom in the differential diagnosis of postoperative shunt complications.