ISOLATED UNILATERAL FETAL PLEURAL EFFUSION - THE ROLE OF SONOGRAPHIC SURVEILLANCE AND IN-UTERO THERAPY

Objective: To discuss the necessity of close sonographic surveillance of small, isolated fetal pleural effusions as well as the selection cr iteria and benefits of in utero therapy utilizing thoracoamniotic shun ts. Methods: High-resolution ultrasound, fetal echocardiography, amnio centesis for viral cultures, cordocentesis, and thoracocentesis were p erformed to evaluate the underlying etiology of a unilateral pleural e ffusion. A Rodeck Rocket shunt was placed following sudden, rapid prog ression of the effusion and onset of severe fetal hydrops. Results: Pl acement of the thoracoamniotic shunt resulted in near-complete drainag e of the pleural effusion with normalization of intrathoracic anatomic relationships, subsequent complete resolution of fetal hydrops, and e xcellent postnatal outcome. Conclusions: Apparently stable, small pleu ral effusions can progress rapidly to severe hydrops and need to be fo llowed closely. In appropriately evaluated and selected cases, thoraco amniotic shunt placement may result in resolution of fetal hydrops and prevent intrauterine fetal death.