The first occurrence of chronic post-thoracotomy pain syndrome after syringopleural shunt: A case report

While post-thoracotomy pain syndrome is a known phenomenon in thoracic surgery, its occurrence after pleural shunt placement has not been described in the literature. A 41-year-old female with a history of Chiari I decompression surgery was admitted with a complaint of paresthesia, neuropathic pain affecting all extremities, and gait difficulty. Cervical magnetic resonance imaging revealed a C2-7 syringomyelia, and a syringopleural shunt was placed. The patient improved both clinically and radiologically, but after four months of follow-up, she complained of pain near the thoracic incision and in the dermatome relevant to the intercostal nerve root. The wound was surgically explored, and reactive changes to the shunt catheter were found near the intercostal nerve root. The shunt was subsequently removed, and a syringoarachnoidal shunt was placed instead. The patient improved postoperatively and was discharged without any complications. In conclusion, careful consideration of the location and course of the intercostal nerves is essential when placing pleural shunt systems.