Diagnostic ultrasound ( PDFDrive )

CHAPTER 41 Fetal Hydrops 1427
C
H
A
B
C
H
C
D
FIG. 41.22 Drainaging of macrocystic congenital pulmonary airway malformation with mediastinal shift and incipient hydrops. (A) shows
a cyst in the cyst (c) with mediastinal shift of the heart (H). (B) shows needle in the largest cyst. (C) shows decreased size of the cyst. Needle
can be seen (arrows). (D) At the completion of the procedure, the heart (H) is less compressed, and the echogenic chest mass (c) can still be
seen, but the large cyst is no longer present.
large efusions may be drained initially using a ine needle and
the luid sent for lymphocyte count (>80% lymphocytes in the
absence of infection is diagnostic of chylothorax), 112 rapid
karyotyping, protein, inclusion bodies, and infection studies.
his maneuver also evaluates the ability of the lungs to reexpand
and may occasionally be therapeutic. Efusions that recollect
rapidly can have multiple drainage procedures or may have shunt
placement. 82,113 With treatment, survival is greater than 60%. 114
For large efusions occurring late in pregnancy, therapeutic
drainage immediately before delivery facilitates neonatal resuscitation.
115 In a 2015 retrospective review of fetuses with congenital
lung lesion or pleural efusion who underwent shunt placement,
97 shunts were placed in 75 fetuses. Average gestational age at
shunt placement and birth was 25 and 35 weeks, respectively.
Shunt placement resulted in a 55% ± 21% decrease in macrocystic
lung lesion volume and complete or partial drainage of the pleural
efusion in 29% and 71% of fetuses. Sixty-nine percent of fetuses
presented with hydrops, which resolved following shunt placement
in 83%. Survival was 68%, which correlated with gestational age
at birth, percent reduction in lesion size, unilateral pleural efusions,
and hydrops resolution. 97
Gastrointestinal Anomalies
Anomalies of the gastrointestinal tract typically cause isolated
ascites rather than hydrops. If there is local obstruction of
lymphatic and venous drainage, as from intestinal obstruction,
volvulus, or omphalocele, hydrops may result in rare cases.
Abdominal masses presumably act by compression of venous