Treatment of unilateral fetal pleural effusion by intrauterine thoracocentesis

Abstract

Fetal pleural effusion refers to an accumulation of fluid in the pleural space. It is most commonly attributed postnatally to chylothorax, a primary lymphatic abnormality. Following the diagnosis of pleural effusion, detailed investigation is essential to exclude other conditions (secondary pleural effusion). The natural history of the lesion is variable. The effusion may resolve spontaneously, remain stable or progress to hydrops and fetal or neonatal demise [1]. The treatment modalities include thoracocentesis, pleuro-amniotic shunting and pleurodesis. The optimal antenatal management is controversial [2,3]. We report a case of isolated pleural effusion diagnosed at 32 weeks of gestation that we successfully treated with thoracocentesis, resulting in a good outcome. The patient was a 30-year-old woman, G2P1A0, referred to our hospital for further management of fetal right pleural effusion at 32 weeks’ gestation. According to the referral information, the pregnancy had been unremarkable until 32 weeks’ gestation. She had not had any illness or recent infectious disease, had not been exposed to teratogenic agents during the pregnancy, and did not have a family history of congenital anomalies. The Down syndrome screen during her second trimester was negative. She had a history of previous cesarean section as a result of preeclampsia and fetal distress. Sonography demonstrated fetal right pleural effusion (Fig. 1). The right lung was compressed and displaced slightly to the midline. There was no evidence of pericardial effusion or gross cardiac defect. There was no other fetal anomaly detectable during the detailed ultrasound examination. One week after the initial visit to our hospital, an increase in the volume of the fetal right pleural effusion occurred. Transabdominal fetal thoracocentesis at 33 2/7 weeks’ gestation was suggested and the patient consented to undergo the procedure. Using a 22-gauge needle and sonographic guidance, 70 mL yellow fluid was removed from the right fetal