CSF hydrothorax: neither migration of peritoneal catheter into the chest nor ascites. Case report and review of the literature

Abstract

CSF hydrothorax following V/P shunt surgery is a very rare complication that may cause serious respiratory distress. It is important to keep in mind that peritoneal catheter migration into the chest may or may not occur. Even ascites may not accompany CSF hydrothorax in a patient without peritoneal catheter migration.

Chemotherapy-induced cerebrospinal fluid malabsorption in a shunted child: case report and review of the literature

“…Conversely, CSF hydrothorax cases without catheter tip migration accounted for 38.9% of cases in the adult and paediatric population 1. Furthermore, in the paediatric setting, ascites accompanied CSF hydrothoracies in 58.3% of cases without catheter tip migration.…”

“…CSF hydrothorax cases are predominantly due to migration of the distal catheter tip 1. In cases without catheter tip migration, over 50% of patients in the paediatric population with a suprasellar glioma develop concomitant CSF ascites.…”

“…The ascites and pleural effusion resolved following the insertion of a VA shunt. This procedure is well documented as the appropriate surgical management in this cohort of patients, as the main problem is peritoneal malabsorption 1 6 7. Other treatment options would depend on the underlying pathology, for example, in cases of CSF overproduction, choroid plexus cauterisation would be the treatment of choice 7…”

CSF Hydrothorax as a Late Complication of Ventriculoatrial Shunt Catheter Displacement

“…The peritoneal catheter may migrate into the thoracic cavity in either a supradiaphragmatic or transdiaphragmatic manner. In supradiaphragmatic migration, the peritoneal catheter is accidentally inserted into and out of the pleural cavity during the tunnelling procedure, especially at the supraclavicular fossa, which is the most dangerous area (6,7). In transdiaphragmatic migration, the peritoneal catheter is gradually pulled into the thoracic cavity due to the negative pressure effect of inspiration.…”

“…Peritoneal malabsorption leads to excessive CSF collection in the peritoneal cavity. CSF may pass through the thoracic cavity via congenital hiatuses (foramen Bochdalek or foramen of Morgagni) with increased intraabdominal pressure (6). Ventriculo-pleural shunts have only been used infrequently for hydrocephalus.…”