A46-13 Symptomatic Pleural Effusion Secondary to Ventriculopleural Shunt

Abstract Introduction Cerebrospinal fluid (CSF) diversion is the mainstay management of hydrocephalus and is commonly achieved using ventriculoperitoneal (VP) shunting. However, alternatives may be required, such as a ventriculopleural (VPL) shunt, when the peritoneal cavity is unsuitable due to prior infections, adhesions or repeated shunt failures. Complications are unique to the specific diversion pathway and understanding the indications/complications of VPL shunts is essential for managing complex hydrocephalus cases. Case A 24-year-old female with past medical history end-stage renal disease on hemodialysis, failed renal transplant, congenital malformation of heart, bilateral VP shunt, bifrontal ventriculopleural shunt, Ogilvie’s syndrome complicated by perforation s/p colonic resection and ileostomy was referred to pulmonary for renal transplant clearance. The patient noted 2 months of ongoing nausea, diarrhea, and right sided trepopnea. On evaluation, vitals were stable, and normal oxygen saturation on room air. Physical exam was notable for absent breath sounds in the left lower lung field. CT Chest demonstrated a large left pleural effusion with evidence of ventricular shunt terminating in the pleural space. Thoracentesis was culture negative and consistent with a transudative effusion. Further review revealed a 4-year history of persistent pleural effusion despite multiple thoracentesis. The presentation was consistent with ventriculopleural shunt associated effusion. Discussion VPL shunts are utilized when traditional ventriculoperitoneal or ventriculoarterial shunt sites are contraindicated. While generally effective and safe, VPL shunts carry risk for pleural complications, with overall reported complication rates ranging from 17-33% over an average four years. Among these, pleural effusions are a common and significant issue. Generally, cases spontaneously resolve, however those which do not need further consideration. In this patient, the presence of a persistent pleural effusion was likely related to CSF drainage exceeding the absorptive capacity of the pleura. Persistent effusions pose a complex management challenge, particularly in patients being evaluated for renal transplantation. Transplant candidacy limits more invasive or high-risk surgical interventions, requiring a multidisciplinary approach to balance respiratory stability, infection prevention, and maintenance of shunt function. Strategies such as the use of anti-siphoning devices or acetazolamide can reduce CSF overdrainage and may offer temporary control while assessing long-term options. In transplant candidates, decisions must carefully weigh the risks of repeated procedures, infection, and fluid shifts that may compromise both pulmonary and renal status. Ultimately, this case underscores the need for individualized management and close coordination between pulmonology, neurosurgery, and transplant teams to ensure both shunt efficacy and transplant readiness while minimizing morbidity. This abstract is funded by: none