Abstract Ventriculoperitoneal (VP) shunt placement is one of the most common neurosurgical procedures, typically utilized to avoid damage from elevated intracranial pressures in conditions such as hydrocephalus and idiopathic intracranial hypertension.1 Most complications occur within the first year and are usually related to infection or mechanical malfunction in the form of shunt disconnection, obstruction, or migration.2,3 Migration most commonly occurs with perforation of the bowel, representing 35% of cases. Chest and thorax migrations are less frequently reported.3 Our patient is a 35-year-old female with a past medical history of idiopathic intracranial hypertension with a VP shunt placed 5 years prior to presentation which required a revision 1-month following insertion. She presented to an outside facility with symptoms of left upper quadrant abdominal pain, nonproductive cough, and subjective fever. She described no headache, weakness, or other neurological symptoms. Computed tomogram (CT) of the abdomen and pelvis revealed the VP shunt catheter traveling through the expected anterior subcutaneous course before traversing into the abdomen and then looping back through the spleen and diaphragm and into the left chest, however the tip was not captured. Subsequent chest imaging demonstrated that the distal tip of the VP shunt catheter was within the left lower lung abutting a left lower lobe subsegmental bronchus with patchy infiltrates of the left lower lobe and right upper lobe. Broad spectrum antibiotic therapy covering community and hospital acquired pathogens was initiated and transferred to our facility for shunt evaluation and surgical management. She underwent a multi-disciplinary shunt revision which was successful and had no immediate complications. CT head and shunt series showed appropriate position of the shunt with stable ventricular size. Her headache improved, and she was discharged home with plans to complete a course of oral antibiotics. VP shunt migration frequently presents with vague symptoms and is often dependent on where the shunt migrates. Although migration into the chest/thorax is a rare complication, respiratory symptoms should raise clinical suspicion for shunt dysfunction and may warrant further evaluation. This abstract is funded by: None
Mayo et al. (Fri,) studied this question.