A rare cause of pleural effusion

A 35-year-old lady presented with left sided pleuritic chest pain. A chest radiograph revealed a small left pleural effusion. She had a ventriculo-peritoneal (VP) shunt placed age 8, for spina bifida complicated by hydrocephalus, and was wheelchair bound but otherwise well. The pleural effusion grew asymptomatically but rapidly over the 3 days after admission to reach a complete white out of her left hemithorax. Preliminary investigations did not identify a cause for her pleural effusion but a CT scan revealed intrapleural tracking of her left VP shunt, ending intraperitoneal. Pleural fluid was positive for beta-2-transferrin, diagnostic for VP shunt leakage.

Thoracic complications of VP shunts, other causes of cerebrospinal fluid pleural leak and the underlying pathophysiology in this case are discussed.