Fabrice Cuillier, MD*; D. Daguindeau, MD**;  J. Bideault, MD**;  Alice Bertha***.

*    Department of Gynecology, Félix Guyon"Hospital, 97400 Saint-Denis, Ile de la Réunion, France;
**   Department of Gynecology, Intercommunal"s Hospital, 97400 Saint-Benois, Ile de la Réunion, France;
***  Student, Arizona State University. University Drive and Mill Avenue Tempe, Arizona 85281.

 

Case report
 
A 25-year-old woman (G1P0) was referred to our antenatal unit at 20 weeks due to a unilateral hydrothorax. There was no known family history of congenital disease and the patient did not use medications. During our ultrasonographic examination we could observe a right sided fetal pleural effusion (images 1, 2, 3, and 4). The heart and great vessels looked normal (images 5, 6), but the pleural effusion caused a shift of the mediastinum and the heart to the left (images 3, 4, and 8).

Serological tests (Toxoplasmosis, Rubeola, CMV, Herpes, Parvovirus and Chikungunya) of the patient were negative. The parents opted for the continuation of the pregnancy. At 22 weeks an amniocentesis was administered and revealed normal karyotype (46 XY).

The isolated abnormal thoracic effusion had the same size at 24 weeks. The right lung was hypoplastic. At 29 weeks the size of the pleural effusion had increased (images 7, 8) and we decided to perform a thoracocentesis that yielded 100 ml of chylous fluid.

At 30 weeks the size of the pleural effusion was identical, but it had increased again at 32 weeks (image 9). The fetus showed signs of cardiac deficiency and second thoracocentesis was performed (150 ml of fluid) after which the thoracal effusion disappeared. Estimated fetal weight was 3000 g. Two days later, the right side effusion appeared again accompanying with signs of cardiac deficiency (ascites). After consultation with the neonatologist, we decided to perform another thoracocenteses (150 ml) and after that a cesarean section was done.

The neonate was intubated and a right thoracic drainage was placed. Nevertheless, the baby died twelve hours later.

An autopsy was practiced and found normal heart, but we couldn’t find any explanation for the isolated right side thoracic effusion.

Images 1, 2: Images show right sided pleural effusion at 20 weeks.

Images 3, 4: Transverse scans of the fetal thorax at 24 weeks of pregnancy showing right sided pleural effusion with hypoplastic right lungs. The mediastinum was shifted to the left and heart looked normal (image 4).

Images 5, 6: Images shows normal outflow tracts of the heart.

Images 7, 8: Parasagittal and transverse scans of the fetal thorax at 29 weeks of pregnancy showing right-sided pleural effusion.

Image 9: 32 weeks of pregnancy; increasing right-sided pleural effusion after previous thoracocentesis at 30 weeks can be seen.

Video 1: This video summarizes the findings described above.