Diagnostic ultrasound ( PDFDrive )

CHAPTER 41 Fetal Hydrops 1417
A B C
D E F
FIG. 41.6 Fetal Pleural Effusions. (A) Unilateral small right pleural effusions. (B) Bilateral pleural effusions in fetus with abnormal heart and
severe skin thickening. (C) Moderate right effusion. Note moderate mediastinal shift to the left. (D) Bilateral moderate effusions. Note how the
partially compressed lungs appear as free-loating “bat wings.” (E) Axial and (F) oblique coronal views of large right pleural effusion. Note the
severe mediastinal shift in E. See also Video 41.2.
FIG. 41.7 Small Pleural Effusion in Association With Congenital
Pulmonary Airway Malformation. Note the large cystic mass (calipers)
and small pleural effusion (arrow).
Subcutaneous Edema
Subcutaneous edema may be localized or generalized (Fig. 41.10),
depending on the cause. A thickness of 5 mm has been suggested
as the cutof value. 11 Edema is most easily seen over the fetal
scalp or face, where thickening of skin overlying bone is visualized
(Figs. 41.10A and 41.11A). It is important to realize that the
biparietal diameter and head circumference measurements are
taken around the skull bone, excluding the skin. Subcutaneous
edema may also be seen over the limbs and abdominal wall.
Care should be taken not to mistake prominent fat in a macrosomic
fetus as anasarca in a hydropic fetus. Subcutaneous edema
will increase the abdominal circumference measurement, beyond
that which is expected for gestational age (Fig. 41.11B). It is
important when measuring the fetus to include the entirety of
the skin in the abdominal circumference measurement, because
this afects the weight calculation of the fetus. hus, when
biometric assessment of the hydropic fetus is performed, the
abdominal circumference measurement is included in the weight
calculation, but it should be excluded from the gestational age
assessment so that the thickened skin does not falsely elevate
estimated fetal age. When generalized subcutaneous edema is
present, the appearances may be referred to as “anasarca” (Fig.
41.12, Video 41.5).