Lung destruction secondary to intrapulmonary migration of a ventriculoperitoneal shunt catheter: report of an unusual ca
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CASE REPORT
Lung destruction secondary to intrapulmonary migration of a ventriculoperitoneal shunt catheter: report of an unusual case and literature review Agustín Ruiz Johnson 1 Beatriz E. Mantese 1
&
Sebastián G. Jaimovich 1 & Aixa Reusmann 2 & Mariana Álvarez 3 & Fabiana J. Lubieniecki 3 &
Received: 9 May 2020 / Accepted: 28 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Ventriculoperitoneal shunt placement for the treatment of hydrocephalus is one of the most common pediatric neurosurgical procedures. Complications, including infections, catheter obstruction, shunt breakdown, and hemorrhage, have been described in the literature. Occasionally, however, uncommon and devastating complications occur. We report a case of a 10-year-old female patient who at birth underwent surgical closure of lumbar myelomeningocele and placement of a CSF shunt at another center. Her neurosurgical follow-up was poor. She presented at our institution with a history of recurrent pneumonia. Control chest X-rays showed a right pulmonary infiltrate with lung retraction and mediastinal shift. Chest and brain CT scans confirmed the intrapulmonary location of the distal catheter tip and ventricular dilation. Surgical shunt revision was performed with removal of the intrapulmonary catheter and placement of a new intraperitoneal catheter. Subsequently, right pneumonectomy was performed with good postoperative recovery of the patient. Intrathoracic migration of the distal catheter of the CSF shunt is an extremely rare complication that may produce severe morbidity. To our knowledge, there have been no previous reports on extensive lung destruction secondary to intrathoracic and intrapulmonary ventriculoperitoneal shunt migration. In patients with CSF shunts and pulmonary symptoms, intrapulmonary catheter migration should be considered. Keywords CSF shunt . Catheter migration . Shunt complication . Lung parenchymal destruction . Case report
Introduction Ventriculoperitoneal shunt placement is one of the most common procedures in pediatric neurosurgery and is often associated with complications, such as malfunction and infection. Sometimes much rarer complications occur, most of which causing greater morbidity. Distal catheter migration to the gastrointestinal and genitourinary organs has been described in the literature. Less frequently, intrathoracic migration to the
* Agustín Ruiz Johnson [email protected] 1
Department of Pediatric Neurosurgery, Hospital de Pediatría S. A. M. I. C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
2
Department of Pediatric Surgery, Hospital de Pediatría S. A. M. I. C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
3
Department of Pathology, Hospital de Pediatría S. A. M. I. C. Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina
mediastinum, pleural space, and intravascular compartment may also occur. Here, we describe an unusual case of transdiaphragmatic intrathoracic distal catheter migration with extensive lung parenchymal destruction.
Case report T
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