* Medical Center of Dr.Muresan, Timisoara, Romania.
** Department of Obstetrics and Gynecology, V. Babes medical University, Timisoara, Romania.
Definition
Hydrothorax is an accumulation of fluid within the pleural space of the thoracic cavity. Primary fetal hydrothorax may present with a wide spectrum of severity ranging from small, harmless effusions, to life-threatening thoracic compression.
Incidence
Estimated incidence of isolated fetal pleural effusions is about 1 in 10 - 15 000 pregnancies. The effusion may be bilateral or more commonly unilateral, and may be associated with other malformations, chromosomal abnormalities, anemia, heart defects, cardiac arrhythmias, and viral infections.
Prognosis
The clinical course of primary fetal hydrothorax is unpredictable. Whereas smaller unilateral effusions might remain stable or even regress, this is rarely the case with larger collections. Bilateral effusions, hydrops, preterm delivery and the lack of antenatal therapy are all associated with poor outcome.
Differential diagnosis
The differential diagnosis between the primary pleural effusion causing the fetal hydrops and the secondary one, caused by the hydrops, may be based on the finding of everted diaphragm that occurs in the case of primary effusion.
Management
Once structural and chromosomal anomalies have been excluded, optimal management depends on gestational age, rate of progression, the development of hydrops and associated maternal symptoms.
For very large effusions with mediastinal shift, hydrops and/or hydramnios, or when there is rapid enlargement of the effusion, fetal intervention is warranted.
Case report
A secundigravida had been sent to our department at 25 weeks of gestation due to fetal hydrothorax that was diagnosed in a private office.
Our examination confirmed the diagnosis of the isolated left-sided hydrothorax (see images 1-3, and video 1). The patient was negative for TORCH and parvovirus infections and the karyotype of the fetus was normal.
Images 1, 2, 3 and video 1: 25 weeks of gestation; the images show transverse scans of the fetal thorax (images 1, 2) and abdomen (image 3). Massive left-sided hydrothorax can be seen. The video demonstrates huge left-sided hydrothorax of the fetus.