Elsevier

The Journal of Emergency Medicine

Volume 16, Issue 1, January–February 1998, Pages 33-36
The Journal of Emergency Medicine

Clinical Communication
Tension Hydrothorax Due to Ventriculopleural Shunting

https://doi.org/10.1016/S0736-4679(97)00238-2Get rights and content

Abstract

Tension hydrothorax is rare, with few cases reported in the literature dating back to the late 1960s. We report a case of tension hydrothorax in a patient with a ventriculopleural shunt who improved dramatically after thoracentesis. The discussion includes a brief review of ventriculopleural shunts and pleural physiology.

Introduction

Massive unilateral tension hydrothorax associated with severe respiratory distress and radiographic evidence of mediastinal compression has been reported in patients with metastatic cancer to the pleura, during hemodialysis, associated with laparoscopic surgery, and in patients with intrathoracic migration of ventriculoperitoneal shunts 1, 2. However, tension hydrothorax due to ventriculopleural shunts has not been reported in the literature. Ventriculopleural shunting for hydrocephalus is occasionally utilized in the short-term management of ventriculoperitoneal shunt infections. We present a case of tension hydrothorax secondary to a ventriculopleural shunt, discuss mechanisms for pleural fluid accumulation, and briefly review ventriculopleural shunts.

Section snippets

Case Report

A 27-year-old male with a history of hydrocephalus complained of chest pain and trouble breathing for 1 day. He was withdrawn and slow to respond to questions. Therefore, much of the history was obtained from his sister who confirmed no acute change in his mental status. He complained of dull, substernal chest pain that worsened with deep inspiration, dyspnea, and low grade fevers. He denied cough, chills, recent chest trauma, localized pain, or orthopnea. Past medical history was significant

Discussion

Ventriculopleural shunts have gone through numerous revisions since their first use in 1914 [3]. Despite the good absorptive capacity of the pleura, a significant percentage of patients develop shunt malfunction or pleural effusions. For these reasons, it is often used only as a temporizing measure during the treatment of shunt infection or when the abdomen has failed to absorb or tolerate cerebrospinal fluid (CSF) [6]. There is an abundance of shunt hardware and almost all are pressure

References (8)

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