Ventriculoperitoneal shunt malfunction presenting with pleuritic chest pain.
BACKGROUND
Ventriculoperitoneal (VP) shunts are widely used for treating hydrocephalus. These devices are prone to malfunction with up to 70% requiring revision. Shunt infection and obstruction comprise the majority of malfunctions and usually present dramatically. However, rare presentations occur.


RESULTS
We report a rare case of VP shunt malfunction presenting with pleuritic chest pain. A 13-year-old girl with a VP shunt placed at birth for congenital hydrocephalus presented on multiple occasions with pleuritic chest pain, cough, and fever. She was diagnosed with an upper respiratory tract infection and discharged home. She returned with respiratory compromise, and chest x-ray depicted the shunt catheter in the pleural space with an associated pleural effusion and infiltrate. The patient fully recovered with intravenous antibiotics, thoracentesis, and placement of a new shunt system.


CONCLUSIONS
VP shunt malfunction usually presents with signs and symptoms of increased intracranial pressure and/or infection. However, unusual presentations of malfunction may occur with signs and symptoms which appear unrelated to the shunt. Thus, all patients with VP shunts warrant a comprehensive evaluation.
Samdani
Amer F
AF
Department of Neurosurgey, Johns Hopkins Hospital, Baltimore, MD 21287, USA. amersamdani@yahoo.com
Storm
Phillip B
PB
Kuchner
Eric B
EB
Garonzik
Ira M
IM
Sciubba
Dan
D
Carson
Benjamin
B
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002637:Chest Pain / Q000209:etiology*; D004635:Emergency Medicine / Q000379:methods; D005260:Female; D005334:Fever / Q000209:etiology; D006261:Headache / Q000209:etiology; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D019547:Neck Pain / Q000209:etiology; D010998:Pleurisy / Q000209:etiology*; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000150:complications / Q000188:drug therapy; D017287:Ventriculoperitoneal Shunt
D000900:Anti-Bacterial Agents