Pränataldiagnostik – Frauenheilkunde am Klinikum Passau, Germany.

Case report

A 38-year-old woman (2G/1P) was sent to our clinic at 23+1 week of gestation due to massive hydrothorax of the fetus and polyhydramnios. The first trimester scan was unsuspicious.

Images 1, 2: Polyhydramnios; well visible 3D image of the fetal face with lot of amniotic fluid around; transverse scan of the fetal abdomen surrounding by abundant amniotic fluid (normally filled stomach is present).

Images 3, 4: Transverse scans of the fetal thorax showing massive hydrothorax with dextroposition of the heart.

Images 5, 6, 7, 8, 9, 10: Transverse scans of the fetal thorax showing well bordered, slightly hyperechoic, intrathoracic mass within the hydrothorax. The heart was dextropositioned and cardiac anatomy was normal. The mass was supplied by a vessel arising directly from the descending aorta (image 10). The findings were suspected of intrathoracic lung sequestration.

The patient was sent to a level III department, to confirm the diagnosis. They decided to insert a pig-tail catheter to decompress the thorax. Hydrothorax had become less prominent after the procedure, but the fetal movements caused releasing of the catheter to the amniotic cavity.

Images 11, 12, 13, 14, 15: The images show released pig-tail catheter within the amniotic fluid close to the fetal legs.

Prof. Dr. med. Christoph Berg from the University of Bonn had decided to perform laser vaporization of the feeding supply within the sequestrated mass (to see more click here: the second case of the video shows our patient).

Images 16, 17, 18, 19: The images show fetal thorax three weeks after the laser vaporization of the feeding vessel of the intrathoracic lung sequestration. Mass of the sequestration was still visible, but the hydrothorax was not present. The heart had moved little bit towards to its normal position and the polyhydramnios had decreased slightly. Vascularization of the sequestered mass was not detectable anymore.

The newborn had been delivered spontaneously at 39⁺¹ weeks in Klinikum Passau, Germany. Now the girl is three years old and is doing well.