What question did this study set out to answer?

To investigate the occurrence of pleural effusion as a complication of ventriculopleural shunts years after placement.

May 20, 2026

A46-08 A Brain-Lung Connection Gone Wrong: Ventriculopleural Shunt Causing Pleural Effusion

INI NietoLakeland Regional Medical Center NKN KosnikLakeland Regional Medical Center TAT AljashamyLakeland Regional Medical Center

Key Points

To investigate the occurrence of pleural effusion as a complication of ventriculopleural shunts years after placement.
Reported a case of a 35-year-old man with congenital hydrocephalus and a history of VPL shunt placement.
Performed imaging studies including chest radiograph and CT to assess pleural effusion.
Conducted thoracentesis and pleural fluid analysis for cytology and biochemical composition.
Detected a moderate right pleural effusion with clear fluid post-thoracentesis, suggesting CSF origin.
Cytology revealed atypical cells, raising concerns for possible malignancy or mesothelial changes.
Emphasized the need for thorough assessment of pleural fluid to guide treatment options.

Abstract

Abstract Pleural effusion secondary to a ventriculopleural (VPL) shunt is uncommon, especially when it presents for the first time many years after placement. We describe an adult with a childhood VPL shunt who was incidentally found to have a new pleural effusion, ultimately suspected to represent cerebrospinal fluid (CSF) accumulation.A 35-year-old man with congenital hydrocephalus, treated in infancy with a ventriculoperitoneal shunt revised to a ventriculopleural configuration during childhood, presented to the emergency department requesting medical clearance for inpatient opioids detoxification. He denied respiratory complaints and vital signs were stable. Chest radiograph demonstrated a small right pleural effusion with adjacent atelectasis. CT chest confirmed a moderate right pleural effusion with the shunt catheter tip positioned in the inferior right hemithorax Figure 1.Thoracentesis removed 750 mL of clear yellow fluid. Pleural studies showed protein 1.3 g/dL, LDH 98 U/L, and triglycerides 9 mg/dL, meeting Light’s criteria for a transudate. Combined with imaging, these findings suggested the effusion represented CSF drainage from the shunt. Unexpectedly, cytology showed atypical cells, raising concern for malignancy versus reactive mesothelial changes secondary to CSF exposure. Unfortunately, the patient declined further testing and was discharged to a rehabilitation center. Pleural effusion is a rare complication of VPL shunts, more often seen in children than adults. The mechanism involves continuous CSF drainage exceeding pleural absorptive capacity or impaired lymphatic clearance. The presence of atypical cells introduces diagnostic uncertainty, emphasizing the importance of correlating cytology with fluid chemistry, imaging, and clinical context. Early recognition and neurosurgical evaluation for possible shunt revision are essential to prevent recurrence or respiratory compromise. This abstract is funded by: None

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