Primary Fetal Hydrothorax: A Literature Review and Proposed Antenatal Clinical Strategy

Abstract

Objective: To investigate the prognostic factors for primitive fetal hydrothorax (PFHT) and propose a clinical strategy based on systematic literature review. Methods: We reviewed 64 articles describing 204 cases of PFHT. For each case we focused on 11 criteria. We investigated prognostic factors in the 89 cases where no in utero treatment was undertaken. We also studied the impact of different in utero treatments on the evolution of PFHT. Results: We have found 4 factors correlated with the course of PFHT: the presence of hydrops, gestational age at time of birth, the unilateral or bilateral nature of the effusion, and the occurrence of spontaneous resolution. With multivariate analysis, only hydrops remained determinant as a prognostic factor. Conclusions: Studies such as ours, reviewing case reports or series, are subject to the biases of literature underreporting of therapeutic failures or nonintervention. However (with the best available data) we propose a clinical approach to PFHT discovered in utero.

Isolated bilateral fetal pleural effusion: diagnosed on antenatal ultrasonography

“…3 It has been associated with congenital malformations like bronchopulmonary sequestrations; congenital cystic adenomatoid malformations and congenital malformations of the lymphatics; Downs' syndrome and Turner's syndrome; congestive heart failure; cardiac defects; pulmonary lymphangiectasia; polydactyly; cystic hygroma; thoracic duct trauma and surgical interventions. [5][6][7] Congenital infections associated with fetal pleural effusions are parvovirus B19, adenovirus and herpes simplex type I. It may occur as part of the overall manifestations of fetal hydrops which is associated with significant fetal mortality.…”

“…the effusion may regress spontaneously; remain stable in size or progress to involve both sides of the chest and produce fetal hydrops, pulmonary hypoplasia and fetal/neonatal demise. 2,5 The cases presenting in second trimester with unilateral pleural effusion and no fetal hydrops are most likely to regress spontaneously. USG along with fetal echocardiography and antenatal karyotyping will often reveal the underlying etiology.…”

Resolution of fetal bilateral chylothorax and ascites after two unilateral thoracocenteses

“…Drainage of the pleural effusion may cause a timely apposition of the visceral and parietal pleura to seal the chylous leak 6 . Aubard et al 8 additionally pointed out that hydrops is a determinant prognostic factor. This case was initially associated with several adverse findings such as bilateral massive pleural effusions, coexistence of fetal ascites, appearance of polyhydramnios, and prenatal detection of hydrothorax prior to 32 weeks' gestation.…”

Congenital chylothorax: current perspectives and trends

“…1,21 In a review of 204 cases of chylothorax, hydrops was the single most important prognostic factor of a poor outcome in CC. 74 Time duration at which conservative management should be considered as failed is not well defined. Some centers use daily drainage as a guide for clinical improvement or failure in pediatric patients (<10 mL/kg/day of pleural drainage is considered as an improvement; >10 mL/kg/day of pleural drainage is considered to be a failure after 4 weeks of nonsurgical management).…”