Ultrasonic Real Time Diagnosis of Hydrothorax before Delivery in an Infant with Extralobar Lung Sequestration

Abstract

A female infant with extralobar lung sequestration (ELS) combined with bilateral hydrothorax and ascites is presented. A 34-year-old para II, pregnant in the 29th gestation week, was referred to hospital because of acute hydramnios. Ultrasound examination demonstrated marked hydramnios, together with ascites and bilateral pleural effusion in the fetus. In the amniotic fluid, alfafetoprotein was found normal and the karyotype showed a normal chromosome pattern, 46 xx. The hydramnios was so severe and the cervix so unripe, that cesarean section had to be undertaken, and a girl of 1650 g, and 42 cm long was born. Just after delivery the infant had bradycardia, cyanosis and respiratory insufficiency, with Apgar score 2 during the first 15 min. Manual ventilation followed by Servo respirator with 100% oxygen was given, but with poor effect. The infant lived only 6 3/4 hours. At autopsy there was hydrothorax, bilateral collapsed lungs and ascites and ELS as the only congenital malformation.

Fetal Hydrothorax in the Second Trimester of Pregnancy: Successful Intra-Uterine Treatment at 24 Weeks Gestation

“…Other causes include lung sequestration [11], diaphragmatic hernia [17], adenoviral infec tion [20] and congenital goitre [21]. They may also be seen as part of fetal hydrops [22], Lymphocytic effusions may be seen in a variety of conditions [18,21], Previous reports where the prominent fe tal abnormality was FHT present either alone or associated with ascites and/or oe dema are summarized in table I.…”

Congenital cystic lung disease: contemporary antenatal and postnatal management

“…Shunting is not an option for fetuses with intrathoracic BPS associated with mediastinal shift and hydrops from a large thoracic mass without pleural effusion. In view of this and since BPS associated with hydrops is uniformly fatal, these patients should be considered for open fetal surgery and resection [93,101,102]. To date, however, this approach has not been reported.…”

“…In these patients, the importance of accurate preoperative identification of venous drainage and arterial supply is brought to light by reports of postoperative fatalities due to ligation of unrecognized anomalous pulmonary veins that comprise the sole or major venous drainage of the ipsilateral lung [96,105]. When cardiac decompensation is the result of a sequestration, embolization of the feeding vessels has been reported [102]. This technique can be used either as definitive treatment or in combination with resection.…”

“…In the long term, however, removal of sequestrations allows compensatory lung growth in the remaining pulmonary tissue [106]. Infants treated for BPS are reportedly at increased risk for gastroesophageal reflux, asthma, pneumonia, and pectus excavatum [102].…”

“…This technique can be used either as definitive treatment or in combination with resection. Complications following this procedure include pain, pyrexia, pleural effusion, transient ischemia of the lower limb, recanalization of the artery, and persistent changes in chest radiographs [102].…”