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Fetal pleural effusion

Dr Abhilash Sandhyala and Dr Yuranga Weerakkody et al.

A fetal pleural effusion (FPE) refers to accumulation of pleural fluid in utero. It can refer to either a fetal chylothorax or a fetal hydrothorax.

Pathology

A fetal pleural effusion can occur as part of hydrops fetalis, in association with other anomalies without hydrops or in isolation - primary pleural effusion / primary fetal hydrothorax (PFHT).

Causes

Any cause of hydrops fetalis is a potential aetiological factor in a fetal pleural effusion

Associations

In addition to hydrops fetalis, a pleural effusion can be associated with numerous other underlying anomalies which include

congenital cardiac anomalies : ~ 5 % of non hydropic pleural effusions ¹
underlying congenital lung anomalies
chromosomal anomalies ^1,3 (can be present in ~ 50% with an additional sonographic abnormality and ~ 12% without an additional sonographic abnormality ⁹)
- Down syndrome : ~ 5 - 33 % of non hydropic pleural effusions ^1,7
- Turner syndrome : especially with a 1^st trimester pleural effusion
- trisomy 18 :
polydactyly : ~ 1 % of non hydropic pleural effusions ¹

Radiographic features

Antenatal ultrasound

Classically seen as anechoic fluid surrounding one or both the lungs (which are echogenic).

Ancilliary sonographic features

may show other features of hydrops if it occurs in association
there maybe presence of polyhydramnios (if severe)

Treatment and prognosis

The clinical course is variable and dependent on aetiology. The presence of a pleural effusion early in pregnancy (i.e first trimester) is often associated with a poor fetal outcome ⁵.

Managment options are also dependent on other underlying factors. Options in selected cases include

thoracocentesis and drainage of the effusion : fluid can however reaccumulate within 24 - 48 hours
insertion of pleural-amniotic shunts.

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