• Jennifer C Smith and Eyal Cohen.
• Division of Pediatric Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto Toronto Canada.
• J Med Case Rep. 2009 Jan 1; 3: 6495.

IntroductionPleural effusion secondary to ventriculoperitoneal shunt insertion is a rare and potentially life-threatening occurrence.Case PresentationWe describe a 14-month-old Caucasian boy who had a ventriculoperitoneal shunt inserted for progressive hydrocephalus of unknown etiology. Two and a half months post-shunt insertion, the patient presented with mild respiratory distress. A chest radiograph revealed a large right pleural effusion and a shunt series demonstrated an appropriately placed distal catheter tip. A subsequent abdominal ultrasound revealed marked ascites. Fluid drained via tube thoracostomy was sent for beta-2-transferrin electrophoresis. A positive test was highly suggestive of cerebral spinal fluid hydrothorax. Post-externalization of the ventriculoperitoneal shunt, the ascites and pleural effusion resolved.ConclusionTesting for beta-2-transferrin protein in pleural fluid may serve as a useful technique for diagnosing cerebrospinal fluid hydrothorax in patients with ventriculoperitoneal shunts.

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