Right pleural effusion due to a migrating ventriculoperitoneal shunt
David P. Meeker, MDAddress reprint requests to D.P.M., Department of Pulmonary and Critical Care Medicine, A90, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
Gene H. Barnett, MD
Pseudotumor cerebri or benign intracranial hypertension is a collection of disorders characterized by papilledema and increased intracranial pressure without associated neurologic abnormalities and wherein the cerebrospinal fluid composition is normal. Therapy may consist of diuretics, acetazolamide, and, in more severe cases, ventricular shunts.SUMMARY
A patient with pseudotumor cerebri and a ventriculoperitoneal shunt presented with dyspnea early in her pregnancy. Chest roentgenography revealed a right pleural effusion and a shunt catheter in the right pleural space. The patient underwent four thoracenteses, and a new shunt was placed after the baby was born.CONCLUSIONS
Physicians should recognize the potential for a ventriculoperitoneal shunt to migrate from the peritoneum to the pleural space. In a pregnant patient, it is reasonable to perform serial thoracenteses as a temporizing measure, and the shunt can be definitively revised in an elective surgical procedure post-partum.