Thoracic complications of ventriculoperitoneal shunts: case report and review of the literature.

Thoracic complications of ventriculoperitoneal shunts are rare, but potentially serious. The authors report a case of a drainage of cerebrospinal fluid into the tracheobronchial tree through a peritoneal shunt catheter that migrated into the chest. After injection of contrast material into the shunt, a plain radiograph of the chest revealed a bronchogram. The symptoms resolved after a revision of the shunt. Published case reports of this and other thoracic complications of ventriculoperitoneal shunts are comprehensively reviewed. A classification of such complications into three types is proposed as follows: intrathoracic trauma during placement of a shunt, migration of the peritoneal catheter into the chest (by either a supradiaphragmatic or a transdiaphragmatic route), and pleural effusion accompanying cerebrospinal fluid ascites. The possible mechanisms and contributing factors are discussed.