Fetal pleural effusion

Last revised by Dr 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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