Severe respiratory failure following ventriculopleural shunt
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Abstract :
Cerebrospinal fluid (CSF) diversion procedure has been used for long to treat hydrocephalus in children. The principle of shunting is to establish a communication between the CSF and a drainage cavity (peritoneum, right atrium, and pleura). Ventriculoperitoneal shunt is used most commonly, followed secondly by ventriculopleural shunt (VPLS). Hydrothorax due to excessive CSF accumulation is a rare complication following both the type of shunts and is more frequently seen with VPLS. We report a case of a 6-year-old female child presenting with massive CSF hydrothorax with respiratory failure following VPLS. The aim of the article is to highlight early recognition of this rare and life-threatening condition, which could easily be missed if proper history is not available.

Case :
A 6-year-old child presented with progressively increasing breathing difficulty for 3 days, there was no fever, cough, or cold. She was being treated with oral antibiotics and salbutamol nebulization by a general practitioner for 3 days. On examination, the patient had tachypnea with severe respiratory distress, oxygen saturation was 70% which increased to around 90% with oxygen, and air entry was diminished on left side with dullness on percussion. The child had tachycardia with normal blood pressure and perfusion. The child was irritable due to hypoxia, but showed no signs of raised intracranial hypertension. The child was intubated due to hypoxemia and put on mechanical ventilator requiring high positive end-expiratory pressure up to 12 cm H2O and 100% oxygen initially for maintaining normal saturations.....