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Hydrothorax and Hydrops

2005-11-28-13 Heron Werner, MD*, Pedro Daltro, MD*, Dorothy Bulas, MD# * Clínica de Diagnóstico por Imagem (CDPI) & Instituto Fernandes Figueira (IFF) – FIOCRUZ – Rio de Janeiro – Brazil
# Professor of Radiology and Pediatrics – Children"s National Medical Center – George Washington University Medical Center – 111 Michigan Ave, NW, Washington D.C. 20010

Hydrops fetalis is defined as fetal skin edema plus effusions in two of three serous cavities including the peritoneal, pleural, or pericardial cavities (Table 1). The relative proportions of these findings can vary, and, in occasional cases, the ascites can be the only real abnormality seen. Fetal ascites can result from severe hemolytic anemia or be a part of a variety of non immune causes that generally have portal hypertension in common. Hydrops fetalis can be divided into immune and nonimmune. In immune hydrops the Rh blood group immunization is the most common. So, the difference between immune and non immune hydrops can be done by the maternal antibody screen. The non immune fetal hydrops is more common, because with the use of anti-D Y-globulin decreased the number of immune hydrops, and with the augmentation of using prenatal ultrasound increased the detection of non immune fetal hydrops. Many causes can be associated with non immune hydrops, but in around 15% of cases, no specific etiologic factor can be detected (Table 2).

Table 1: Caracteristics of hydrops fetalis

Skin edema

Pleural effusion

Pericardia effusion

Ascites

Polyhydramnios

Placental edema

Table 2: Some causes of hydrops fetalis

Fetal anemia (isoimmunization, fetal infection, hemolysis or hemorrhage)

Cardiac failure (structural heart defect or rhythm anomalies)

Arteriovenous malformation (sacrococcigeal teratoma)

Pulmonary defects

Cranial defects

Gastrointestinal and hepatic defects

Renal defects (hypoalbuminemia)

Inhered metabolic disorders

Genetic syndromes and chromosomal abnormalities

Placental abnormalities (arteriovenous malformations)

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