Ventriculoperitoneal (VP) shunting is a common method used to treat hydrocephalus; however, it can cause a variety of complications, such as infection, dysfunction, malposition and over-drainage. Pleural effusion is an uncommon complication of VP shunting and is usually associated with diaphragm defects. Refractory massive pleural effusion can cause respiratory failure. Surgical intervention is usually needed to correct the VP shunt-related pleural effusion. Here, we describe the case of a 51-year-old man who presented with respiratory failure due to persistent massive right-sided pleural effusion, caused by dislocation of the distal tip of the VP shunt catheter. After surgical revision of the VP shunt catheter and proper drainage, the pleural effusion was eliminated.