title: Pleural effusion in a child with a ventriculoperitoneal shunt and congenital heart disease.
abstract: We present the unique case of an 8 month old infant who required extracorporeal membrane oxygenation (ECMO) after neonatal repair of tetralogy of Fallot. While on ECMO, he developed grade 3 intraventricular hemorrhage resulting in hydrocephalus requiring ventriculoperitoneal (VP) shunt placement at 5 months of life. He presented to cardiology clinic with a 2-month history of poor weight gain, tachypnea, and grunting and was found to have a large right sided pleural effusion. This was proven to be cerebrospinal fluid (CSF) accumulation secondary to poor peritoneal absorption with subsequent extravasation of CSF into the thoracic cavity via a diaphragmatic defect. After diaphragm repair, worsening ascites from peritoneal malabsorption led to shunt externalization and ultimate conversion to a ventriculoatrial (VA) shunt. This is the second reported case of VA shunt placement in a child with congenital heart disease and highlights the need to consider CSF extravasation as the cause of pleural effusions in children with VP shunts.
authors: Department of Pulmonary and Sleep Medicine, Children's Hospital of Wisconsin/Medical College of Wisconsin, 9000 W. Wisconsin Ave MS B620, Milwaukee, WI 53226 USA.
authors: Jennifer
authors: J
authors: Henningfeld
authors: Department of Cardiology, Children's Hospital of Wisconsin/Medical College of Wisconsin, 9000 W. Wisconsin Ave, MS 713, Milwaukee, WI 53226 USA.
authors: Rohit S
authors: RS
authors: Loomba
authors: Department of Pulmonary and Sleep Medicine, Children's Hospital of Wisconsin/Medical College of Wisconsin, 9000 W. Wisconsin Ave MS B620, Milwaukee, WI 53226 USA.
authors: Santiago
authors: S
authors: Encalada
authors: Department of Critical Care, Children's Hospital of Wisconsin/Medical College of Wisconsin, 9000 W. Wisconsin Ave MS 681, Milwaukee, WI 53226 USA.
authors: Kristin
authors: K
authors: Magner
authors: Department of Critical Care, Children's Hospital of Wisconsin/Medical College of Wisconsin, 9000 W. Wisconsin Ave MS 681, Milwaukee, WI 53226 USA.
authors: Jennifer
authors: J
authors: Pfister
authors: Department of Neurosurgery, Children's Hospital of Wisconsin/Medical College of Wisconsin, 999 N 92nd St. Suite 310, Milwaukee, WI 53226 USA.
authors: Anne
authors: A
authors: Matthews
authors: Department of Neurosurgery, Children's Hospital of Wisconsin/Medical College of Wisconsin, 999 N 92nd St. Suite 310, Milwaukee, WI 53226 USA.
authors: Andrew
authors: A
authors: Foy
authors: Department of Critical Care, Children's Hospital of Wisconsin/Medical College of Wisconsin, 9000 W. Wisconsin Ave MS 681, Milwaukee, WI 53226 USA.
authors: Theresa
authors: T
authors: Mikhailov
keywords: Congenital heart disease; Effusion; Shunt; Ventriculoatrial; Ventriculoperitoneal