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 criteria and benefits of in utero therapy utilizing thoracoamniotic shunts. Methods: High-resolution ultrasound, fetal echocardiography, amniocentesis for viral cultures, cordocentesis, and thoracocentesis were performed to evaluate the underlying etiology of a unilateral pleural effusion. A Rodeck Rocket shunt was placed following sudden, rapid progression of the effusion and onset of severe fetal hydrops. Results: Placement of the thoracoamniotic shunt resulted in near-complete drainage of the pleural effusion with normalization of intrathoracic anatomic relationships, subsequent complete resolution of fetal hydrops, and excellent postnatal outcome. Conclusions: Apparently stable, small pleural effusions can progress rapidly to severe hydrops and need to be followed closely. In appropriately evaluated and selected cases, thoracoamniotic shunt placement may result in resolution of fetal hydrops and prevent intrauterine fetal death.