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

INTRODUCTION: Complications of ventriculoperitoneal (V/P) shunt surgery are generally due to infection, or mechanical or dynamic dysfunction. Thoracic complications like cerebrospinal fluid (CSF) hydrothorax are rarely seen. PATIENT AND METHODS: We present a CSF hydrothorax patient as a rare complication of V/P shunt surgery and review of the literature. The patient was a 7-month-old girl who had V/P shunt surgery for hydrocephalus. Six months after surgery, she was admitted to hospital with the complaint of cough. As the chest X-ray revealed hydrothorax, a chest tube was inserted. Although her shunt tip was in the abdominal cavity in shuntograms, positive beta-2 transferrin in liquid sample and Tc 99m cisternography proved that it was CSF. After we replaced her V/P shunt with a ventriculoatrial shunt, the liquid coming from the chest tube progressively diminished and disappeared, and her chest tube was removed.
RESULTS: There are 36 CSF hydrothorax cases, including the present case, in the literature. There is peritoneal catheter migration into the chest in 22 of them (61.1 %). Half of the remaining 14 cases (38.9 %) without catheter migration have also CSF ascites. But, in the other half (seven cases), there is neither catheter migration nor CSF ascites as in the present case.
CONCLUSION: 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.