Fetal ‘black lung’ on PMMR: Fetocide related?

Abstract

This fetus underwent late termination of pregnancy (third trimester) for antenatally sonographically diagnosed severe renal tract abnormalities. At PMMR, both kidneys were markedly enlarged, almost 6 cm in length, with a collapsed thick-walled bladder, confirmed to be autosomal recessive polycystic kidney disease at autopsy (not shown). However, we noticed that the right lower lobe demonstrated very low signal on T2-weighted imaging, with a clear lobar distribution (Fig. 1b and e). This has an unusual configuration for most typical perinatal lung parenchymal pathology found in this setting (e.g. congenital pulmonary airway malformation; congenital lobar emphysema). Both right and left lower lobes were resected in their entirety at autopsy, and both had normal and comparable macroscopic (Fig. 1a and c) and microscopic appearances (Fig. 1d and f). We have now encountered this on two occasions, and, in conjunction with intracardiac and pleural gas, we hypothesize that these changes are related to the mode of late termination, with intracardiac injection of potassium chloride, accessed through the right chest wall where the needle may have traversed the right lower lobe with some extravasation of agent into the lung.