Ferreira N P, Costa D M, Flores J A
Arq Neuropsiquiatr. 1980 Dec;38(4):415-8. doi: 10.1590/s0004-282x1980000400013.
A child, who had undergone ventriculoperitoneal shunting, presented with repeated episodes of pneumonia and expectoration of CSF. Chest x-ray demonstrated the presence of the shunt catheter in the base of the left lung. In the present case the distal end of the catheter perforated the diaphragm, entering the thoracic cavity through the pleura and penetrating the pulmonary parenchyma. CSF then flowed freely into the alveoli and bronchi and became expectorated during repeated bouts of coughing associated with pneumonia. This respiratory complication disappeared after the removal of the catheter. We theorize that the penetration of the catheter into the thoracic cavity was secondary to its displacement from the iliac fossa to the left infradiaphragmatic space between the spleen and the diaphragm where the intra-abdominal pressure is lowest. The respiratory movements and the hypertension inside the abdomen created a constant friction of the catheter against the diaphragm which was finally perforated, permitting the passage of the peritoneal end of the shunting device into the thoracic cavity and secondary penetration of the lung.
一名接受过脑室腹腔分流术的儿童出现反复肺炎发作及脑脊液咳出症状。胸部X线显示左肺底部存在分流导管。在本病例中，导管远端穿透膈肌，经胸膜进入胸腔并穿透肺实质。脑脊液随后自由流入肺泡和支气管，并在与肺炎相关的反复咳嗽发作期间咳出。拔除导管后，这种呼吸系统并发症消失。我们推测，导管进入胸腔是由于其从髂窝移位至脾脏与膈肌之间腹腔压力最低的左膈下间隙。腹部的呼吸运动和高血压导致导管与膈肌持续摩擦，最终膈肌被穿透，使分流装置的腹膜端进入胸腔并继发肺穿透。
