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Pleural effusion in a child with a ventriculoperitoneal shunt and congenital heart disease. Springerplus 2016;5:90 PMID: 26848430 PMCID: PMC4729718

Pubmed ID



We present the unique case of an 8 month old infant who required extracorporeal membrane oxygenation (ECMO) after neonatal repair of tetralogy of Fallot. While on ECMO, he developed grade 3 intraventricular hemorrhage resulting in hydrocephalus requiring ventriculoperitoneal (VP) shunt placement at 5 months of life. He presented to cardiology clinic with a 2-month history of poor weight gain, tachypnea, and grunting and was found to have a large right sided pleural effusion. This was proven to be cerebrospinal fluid (CSF) accumulation secondary to poor peritoneal absorption with subsequent extravasation of CSF into the thoracic cavity via a diaphragmatic defect. After diaphragm repair, worsening ascites from peritoneal malabsorption led to shunt externalization and ultimate conversion to a ventriculoatrial (VA) shunt. This is the second reported case of VA shunt placement in a child with congenital heart disease and highlights the need to consider CSF extravasation as the cause of pleural effusions in children with VP shunts.

Author List

Henningfeld J, Loomba RS, Encalada S, Magner K, Pfister J, Matthews A, Foy A, Mikhailov T


Andrew Foy MD Associate Professor in the Neurosurgery department at Medical College of Wisconsin
Jennifer Henningfeld MD Assistant Professor in the Pediatrics department at Medical College of Wisconsin
Kristin Magner NP Nurse Practitioner Peds Crit Care in the Pediatrics department at Medical College of Wisconsin
Theresa A. Mikhailov MD, PhD Professor in the Pediatrics department at Medical College of Wisconsin

jenkins-FCD Prod-299 9ef562391eceb2b8f95265c767fbba1ce5a52fd6