A child’s hydrocephalus shunt migrated into the chest, causing recurring lung collapse

In a five-year-old girl, the misplaced shunt formed an air leak near the lung that required chest drainage and shunt repositioning.

Abstract editorial illustration accompanying the article: A child’s hydrocephalus shunt migrated into the chest, causing recurring lung collapse

Editorial illustration — not from the study.

Doctors reported the case of a five-year-old Mauritian child with cerebral palsy and hydrocephalus who developed a large right-sided pneumothorax several months after shunt placement. The air buildup compressed the lung and shifted structures in the chest, leading to respiratory distress. The pneumothorax returned after the first chest tube was removed.

A contrast study showed that the shunt had traveled through the diaphragm toward the chest and was linked to the bronchial tree by an abnormal passage. A chest tube treated the immediate pressure, while repositioning the shunt addressed the suspected cause and was followed by rapid improvement.

How the shunt caused trouble

A chest radiograph showed a very large right-sided tension pneumothorax, with compression of the lung and a shift of the central chest structures. After a chest tube was inserted, the lung gradually re-expanded, but the pneumothorax returned seven days after the tube was removed and required another drain when the child became short of breath.

A fluoroscopic contrast study of the shunt showed a fistulous connection crossing the diaphragm and pleural space between the shunt tip and a branch of the right bronchial tree. The authors concluded that the shunt had migrated from the abdomen toward the chest and that an airway injury had allowed air to enter the pleural space. Repositioning the shunt, together with chest treatment, was followed by rapid improvement.

Why the complication matters

The case shows that a recurring pneumothorax or persistent breathing difficulty after ventriculoperitoneal shunt placement can signal a chest-related shunt complication, even months after the operation. The report also describes a contrast study as a way to identify the abnormal connection without computed tomography, which may help centers with limited imaging resources evaluate similar cases. Because tension pneumothorax can be serious, the authors emphasize urgent treatment and shunt repositioning when this complication is suspected.

Evidence and caveats

This is a report of one child, not a study testing treatment across a group of patients. The timing between shunt placement and the first pneumothorax was not recorded, and the exact original cause of the shunt’s position and airway injury remained uncertain. The authors considered previous infection of the shunt tract as one possible explanation, but the report did not establish it.

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