Enteric cyst as a cause of nonimmune hydrops fetalis: Fetal thoracentesis with fluid analysis

Abstract

Cystic abnormalities of the fetal thoracic cavity visualized antenatally by ultrasonography can be due to a variety of anomalies including cystic adenomatoid malformation, pulmonary sequestration, bronchogenic cyst, and diaphragmatic hernia. The presence of these anomalies alone and/or the simultaneous accumulation of pleural fluid can impede lung development in the fetus. Therefore the detection and early treatment of these lesions can be crucial to fetal survival. We report the rare occurrence of an enteric cyst that presented in a fetus as a cystic intrathoracic lesion with associated hydrothorax and eventually fetal hydrops. In utero thoracentesis was performed for possible diagnostic and therapeutic indications, and analysis of the fluid obtained from the cyst prenatally and postnatally is reported. CASE REPORTA 20-year-old G2 PI Abl white female was referred to Indiana University Medical Center at 29% weeks gestation when an ultrasound examination, obtained because of a discrepancy between estimated fetal size and menstrual age, revealed fetal intrathoracic fluid. A highresolution ultrasound examination at 30 weeks to 31 weeks of menstrual age confirmed the presence of marked hydramnios and the complete echoluscency of the right hemithorax measuring 7.6 cm x 5.6 cm x 3.9 cm, consistent with hydrothorax or a large intrapulmonary cyst. There