Fetal pleural effusion

Last revised by Owen Kang on 11 Nov 2017

Fetal pleural effusions (FPE) refer to an accumulation of pleural fluid in utero. It can refer to either a fetal chylothorax or a fetal hydrothorax.

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).   

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

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

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

Ancillary sonographic features include:

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

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

Management options are also dependent on other underlying factors:

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

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Cases and figures

  • Case 1: occurring with hydrops fetalis
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  • Case 2: with hydrops fetalis
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  • Case 3: with hydrops fetalis
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