Perinatology Unit, Carabobo University, Valencia - Venezuela

This is a 31-year-old primigest with an unremarkable pregnancy. At 15 weeks she has an amniocentesis for an elevated screening test for trisomy 21. A normal male karyotype is obtained.

At 27 weeks a left hydrothorax is visible but since there is no mediastinal shift we elected to observe her weekly. At 28 weeks the hydrothorax has increased and resulted in a mediastinal shift with dextrocardia. We performed a thoracocentesis, drained 50 cc of fluid and attempted a pleurodesis with intrapleural triamcinolone.

The analysis of the pleural fluid revealed 100% lymphocytes.

The pleural effusion recurred at 29 weeks, at which time a repeat tap with drainage of another 40cc was performed.

At 30 weeks we decided to place a thoraco-amniotic shunt (double pigtail Harrison shunt). Shunt placement and function were satisfactory. Doppler indices of pulmonary resistance progressively decreased.

November 11:

November 27:

November 30:

December 16:

January 4:

At 39 weeks the shunt migrated into the thorax, and an elective cesarean section was performed. The Apgars were 9 & 10.

The postnatal evolution of the baby was unremarkable. The X-ray confirmed the intrathoracic location of the shunt.