Ultramed, Quevedo, Ecuador.

Case report

This is a 27-year old G3P0A2 with two previous pregnancies losses at 8 weeks without definitive diagnosis. At 9th week of pregnancy the following images were obtained:

Images 1 and 2: 9th week of pregnancy. Gray scale images showing hypoechogenic areas (early bilateral pleural effusion) around fetal heart.

Image 3: 9th week of pregnancy. Color Doppler image showing the heart surrounding by hypoechogenic areas (early pleural effusion).

Three weeks later (12 weeks) the effusion surrounded the heart disappeared but the evident massive fetal edema with markedly enlarged nuchal translucency was visible. The nasal bone was absent and the ductus venosus waveform showed reversed atrial flow. After the ultrasound a chorion villous sampling was done and the reported result was a Trisomy 21. The parents opted for termination of the pregnancy.

Images 4 and 5: 12 weeks of pregnancy. Image 4 - color Doppler transverse scan through the fetal chest showing the heart and lung without previous effusion; and Image 5 showing ductus venosus waveform with reversed atrial flow.

Images 6 and 7: 12 weeks of pregnancy. Gray scale images showing massive fetal edema.

Image 8: 12 weeks of pregnancy. Gray scale sagittal image showing absent nasal bone and depressed nasal bridge.

Based on the evolutive scans and the result of CVS we considered the sonolucent areas surrounding the heart to be compatible with a very early bilateral pleural effusion

Note from Philippe Jeanty: We have seen several cases similar to this one and we suspect that this is just a transient physiological embryologial visualization of the pleuro-pericardial sac as it develops. Further cases need to be accumulated but the pleural effusion may just be a normal phenomenon.