Isolated Unilateral Fetal Pleural Effusion: The Role of Sonographic Surveillance and in utero Therapy

Abstract

Objective: To discuss the necessity of close sonographic surveillance of small, isolated fetal pleural effusions as well as the selection criteria and benefits of in utero therapy utilizing thoracoamniotic shunts. Methods: High-resolution ultrasound, fetal echocardiography, amniocentesis for viral cultures, cordocentesis, and thoracocentesis were performed to evaluate the underlying etiology of a unilateral pleural effusion. A Rodeck Rocket shunt was placed following sudden, rapid progression of the effusion and onset of severe fetal hydrops. Results: Placement of the thoracoamniotic shunt resulted in near-complete drainage of the pleural effusion with normalization of intrathoracic anatomic relationships, subsequent complete resolution of fetal hydrops, and excellent postnatal outcome. Conclusions: Apparently stable, small pleural effusions can progress rapidly to severe hydrops and need to be followed closely. In appropriately evaluated and selected cases, thoracoamniotic shunt placement may result in resolution of fetal hydrops and prevent intrauterine fetal death.

Congenital chylothorax: Associations and neonatal outcomes

“…Fetal hydrops is another complication reported in literature associated with chylothorax . Nearly two out of three infants in our cohort had a diagnosis of fetal hydrops.…”

“…Fetal hydrops is another complication reported in literature associated with chylothorax. 5,13 Nearly two out of three infants in our cohort had a diagnosis of fetal hydrops. Even though presence of hydrops did not alter the overall survival of these infants, its presence did lead to the need for pleural fluid drainage in delivery room and aggressive ventilation in the initial neonatal period.…”

“…In our series, 50% of infants had some antenatal intervention, which included in utero pleural tap or amnioreduction for polyhydramnios. The therapeutic benefit of antenatal drainage relates to resolution of fetal hydrops and prevention of pulmonary hypoplasia and intrauterine fetal death . More recently, intrapleural injection of OK‐432 in the fetal period has been advocated as alternative to the traditional drainage, or pleuro‐peritoneal shunts .…”

“…The therapeutic benefit of antenatal drainage relates to resolution of fetal hydrops and prevention of pulmonary hypoplasia and intrauterine fetal death. 13 More recently, intrapleural injection of OK-432 in the fetal period has been advocated as alternative to the traditional drainage, or pleuroperitoneal shunts. 14 Also, antenatal confirmation of chylothorax may aid in the early diagnosis of rare, related conditions.…”

Thoracoamniotic Shunting with Double-Basket Catheters for Fetal Chylothorax in the Second Trimester

“…In addition, the effusion can act as space occupying masses displacing mediastinal structures, leading to hemodynamic changes and the onset of nonimmune fetal hydrops [1] . Because of this, a pleuro-amniotic shunt is a logical treatment for severe cases of pleural effusion in the second trimester.…”