Diagnostic ultrasound ( PDFDrive )

1414 PART IV Obstetric and Fetal Sonography
TABLE 41.1 Nonimmune Hydrops: Common Causes and Associations a
Cause
(Percentage of
Nonimmune Hydrops)
Mechanism
Examples
Cardiovascular (20%) Increased central venous pressure Structural heart disease (hypoplastic left or right
heart syndrome, atrioventricular canal)
Myocardial or pericardial tumors (rhabdomyoma in
tuberous sclerosis)
Tachyarrhythmia
Bradyarrhythmia (congenital heart block [anti-Rho]
or other maternal autoimmune disease)
Monochorionic twins
(4%)
Lymphatic dysplasia
(15%)
Neck/chest (2%)
Gastrointestinal (1%)
Urinary tract (1%)
Aneuploidy (13%)
Hematologic (9% b )
Infection (7%)
Inborn errors of
metabolism (1%)
Other syndromes
(5.5%)
Extrathoracic tumors
(1%)
Maternal
Placental/cord
Idiopathic 20%
Anemia and/or high-output cardiac failure
Abnormal lymphatic drainage
Vena caval obstruction or increased
intrathoracic pressure with impaired
venous return
Obstruction of venous return,
gastrointestinal obstruction and infarction
with protein loss and decreased colloid
osmotic pressure
Urinary ascites; nephrotic syndrome with
hypoproteinemia
Cardiac anomalies, lymphatic dysplasia,
anemia, abnormal myelopoiesis
Anemia, high-output cardiac failure; hypoxia
(α-thalassemia)
Anemia, anoxia, endothelial cell damage,
increased capillary permeability,
myocarditis
Anemia
Hemolysis
Visceromegaly, obstruction of venous
return, decreased erythropoiesis,
anemia, hypoproteinemia
Anemia, high-output cardiac failure,
hypoproteinemia
a Adapted from references 4, 23, 36, 43, 226, and 230-237.
b Much higher percentage of hydrops in regions with α-thalassemia, such as Southeast Asia.
Twin-to-twin transfusion syndrome (usually the
recipient but can occur in the donor), twin
anemia polycythemia sequence
Acardiac twin (donor)
Congenital lymphatic dysplasia
Cystic hygroma
Congenital high airway obstruction
Pleural effusion (chylothorax)
Chest mass (congenital pulmonary airway
malformation, sequestration, congenital
diaphragmatic hernia)
Portal vein thrombosis
Volvulus
Obstruction
Meconium peritonitis
Finnish nephrosis, urinary tract obstruction
45,XO, trisomy 21, trisomy 18, triploidy
α-Thalassemia (homozygous)
Fetomaternal transfusion
Parvovirus, cytomegalovirus, adenovirus, syphilis,
toxoplasmosis
Lysosomal storage disease,
mucopolysaccharidoses,
Gaucher disease, Niemann-Pick disease
G6PD deiciency
Noonan syndrome
Skeletal dysplasias such as achondroplasia,
osteogenesis imperfecta, thanatophoric
dysplasia arthrogryposis, congenital myotonic
dystrophy
Vascular/lymphatic tumors
Teratoma, neuroblastoma, arteriovenous
malformation
Severe diabetes mellitus, severe anemia, severe
hypoproteinemia, thyrotoxicosis
Indomethacin use (premature closure of ductus
arteriosus)
Placental or umbilical vein thrombosis, cord knot,
chorioangioma