Challenges of Retained Thoracoamniotic Shunts in the Neonatal Period: A Case Report

<b>Background:</b> Thoracoamniotic shunting (TAS) is a well-established fetal therapy for severe pleural effusions complicated by hydrops. Although survival in selected cases exceeds 60%, retained or migrated shunts can pose significant postnatal management challenges. <b>Case presentation:</b> We report a neonate with intrathoracic migration of a Somatex^® shunt placed at 26 weeks' gestation for hydropic pleural effusion. Although initially asymptomatic, the infant developed recurrent pleural effusions requiring multiple readmissions. Thoracoscopic retrieval on day 76 of life allowed safe removal despite dense adhesions, leading to complete clinical resolution. <b>Discussion:</b> Retained thoracoamniotic shunts may remain asymptomatic or cause recurrent effusions, pneumothorax, or other complications. This case highlights the limitations of conservative management in the presence of clinical deterioration and supports timely surgical removal. Standardized criteria for intervention are lacking and urgently needed. <b>Conclusions:</b> In infants with retained TAS, recurrence of effusions or respiratory compromise should prompt active removal. Thoracoscopic retrieval is a safe and effective minimally invasive option.