CASE PRESENTATION: 38-year-old female with history of Chiari I malformation and communicating hydrocephalus managed with right frontal VP shunt insertion in 2014 presented with two-week history shortness of breath and productive cough, white sputum 15 months post-procedure. Physical examination: temperature 100.7°F, pulse 124 beats/minute, increased work of breathing, and absent breath sounds on entire right lung field. Laboratory results significant WBC 13,200 cells/mcL. Chest CT revealed VP shunt located within RT pleural effusion (Figure 1). Thoracentesis revealed yellow, non-purulent fluid, total protein 2.8 g/dL, lactate dehydrogenase 218 U/L & culture negative. Chest tube was placed. Right frontal VP shunt was removed, and left frontal VP shunt placed without complications. Respiratory symptoms improved thus chest tube was removed. Patient was discharged home.