Ioan-Alexandru Florian, Paula Topal, Teodora-Larisa Florian, Dragos Font, Ioan-Stefan Florian
{"title":"Implausible, not impossible: delayed supradiaphragmatic thoracic migration of a ventriculoperitoneal shunt in a 17-month-old.","authors":"Ioan-Alexandru Florian, Paula Topal, Teodora-Larisa Florian, Dragos Font, Ioan-Stefan Florian","doi":"10.1007/s00381-024-06670-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Intrathoracic migration of a ventriculoperitoneal shunt (VPS) is a phenomenally rare complication, with the supradiaphragmatic intercostal variant even more so. Whereas it can prove debilitating or even fatal via massive hydrothorax, the causative mechanism and proper management of this occurrence are undefined.</p><p><strong>Case presentation: </strong>A 17-month-old girl who had undergone VPS insertion at one month of age was brought to our department for somnolence and dyspnea, which had a sudden onset. Despite a previous thoracostomy provided temporary symptom relief, she had relapsed. Computed tomography (CT) of the chest showed a large loop of the right-sided VPS penetrating into the thorax through the anterior wall, as well as marked right hydrothorax. She was subjected to VPS revision and thoracostomy, with the swift, complete, and lasting remission of her complaints.</p><p><strong>Conclusion: </strong>It is possible that local reaction coupled with negative inspiratory pressure caused the catheter loop to break into the pleural cavity. Our case demonstrates an exceedingly rare event that has a favorable prognosis if diagnosed and treated quickly and appropriately.</p>","PeriodicalId":9970,"journal":{"name":"Child's Nervous System","volume":"41 1","pages":"35"},"PeriodicalIF":1.3000,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11621144/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Child's Nervous System","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00381-024-06670-8","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
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Abstract
Background: Intrathoracic migration of a ventriculoperitoneal shunt (VPS) is a phenomenally rare complication, with the supradiaphragmatic intercostal variant even more so. Whereas it can prove debilitating or even fatal via massive hydrothorax, the causative mechanism and proper management of this occurrence are undefined.
Case presentation: A 17-month-old girl who had undergone VPS insertion at one month of age was brought to our department for somnolence and dyspnea, which had a sudden onset. Despite a previous thoracostomy provided temporary symptom relief, she had relapsed. Computed tomography (CT) of the chest showed a large loop of the right-sided VPS penetrating into the thorax through the anterior wall, as well as marked right hydrothorax. She was subjected to VPS revision and thoracostomy, with the swift, complete, and lasting remission of her complaints.
Conclusion: It is possible that local reaction coupled with negative inspiratory pressure caused the catheter loop to break into the pleural cavity. Our case demonstrates an exceedingly rare event that has a favorable prognosis if diagnosed and treated quickly and appropriately.
期刊介绍：
The journal has been expanded to encompass all aspects of pediatric neurosciences concerning the developmental and acquired abnormalities of the nervous system and its coverings, functional disorders, epilepsy, spasticity, basic and clinical neuro-oncology, rehabilitation and trauma. Global pediatric neurosurgery is an additional field of interest that will be considered for publication in the journal.
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