Pleural Effusion (Hydrothorax) and Congenital Chylothorax

What are the signs and symptoms of pleural effusions and chylothorax?

We diagnose pleural effusions, including chylothorax, before birth by fetal ultrasound imaging. Through this imaging, your doctor may see fluid surrounding the lungs of your baby.

In other forms of pleural effusions, fluid collects in other areas of the body, such as pericardial effusion (fluid around the heart), edema (fluid under the skin) and ascites (fluid in the abdominal cavity). When two or more of these spaces are filled with fluid, the condition is called fetal hydrops or hydrops fetalis.

The main risk for babies still in the womb with pleural effusions is that fluid buildup can compress the lung, not letting it fully develop. This is called pulmonary hypoplasia and can cause severe problems once the baby is born, making it hard to breathe and sometimes even leading to death.

What tests do we use to diagnose pleural effusions and chylothorax?

We use several tests to diagnose pleural effusions and find its causes. A fetal ultrasound helps us learn the type of effusion. A fetal echocardiogram (a fetal heart ultrasound) and amniocentesis for genetic and infectious testing can help us learn what causes the fluid buildup.

Amniocentesis is a procedure in which we pass a long, thin needle into the mom’s uterus and into the amniotic fluid, which surrounds the baby. We take this fluid out and test it for genetic issues and infectious diseases.

We can also see if there is fluid in the baby’s chest by performing thoracentesis, in which we pass a long, thin needle into the mom’s uterus and into the baby’s chest. We can take fluid from the chest and look at the type of cells in the fluid, which will help us diagnose congenital chylothorax and fetal hydrops.

What can I expect from pleural effusions and chylothorax tests?

Amniocentesis and thoracentesis procedures do not cause the mother much discomfort. They may feel pressure, a cramp or a slight pinch as the needle passes through the uterus. Infectious and genetic testing results typically take 7 to 10 days.

To diagnose for congenital chylothorax, we perform a thoracentesis procedure and test the fluid sample. When the lymph cells (called lymphocytes) are high, it means the fluid is coming from the “leaky” thoracic duct in the baby’s chest. This information gives our fetal care specialists the cause for the fluid buildup and allows for further counseling. The thoracentesis procedure and analysis of the chest fluid typically take less than 2 hours.

These tests carry a very small risk for miscarriage or pregnancy loss and the risk for this is about 1 loss for every 800 procedures performed. In general, the risk of the fetal condition of pleural effusions and chylothorax are a much greater risk and understanding the cause with testing is important in treatment decisions.

How do we treat pleural effusions and chylothorax?

Congenital pleural effusions treatment depends on what causes the extra fluid. If the cause is heart, genetic or infectious condition, we can’t usually treat them in the womb, but can after birth.

In other cases, we can treat congenital chylothorax by draining the fluid from the chest. We can do this with thoracentesis using a single needle. However, when chylothorax is the cause of pleural effusions the fluid typically builds up again and may require a fetal thoracoamniotic shunt. This treatment means placing a small tube into the fluid-filled chest cavity through the chest wall, leaving the other end of the tube to drain into the amniotic cavity (the space surrounding the baby filled with amniotic fluid).

One infectious cause called parvovirus B-19 is reversible. This causes anemia (a lack of healthy red blood cells) in the unborn baby that can lead to heart failure and fetal hydrops. We can perform a fetal blood transfusion to increase the blood count. The transfusion usually ends the effects of the infection and the baby will likely recover with no long-term effects.

Why choose us for treatment of pleural effusions and chylothorax?

Although these conditions are rare, we commonly see and treat them at the Colorado Fetal Care Center at Children’s Hospital Colorado. Because we’re one of the most experienced fetal care centers in the country with the most advanced technology, we treat even the rarest of conditions related to congenital pleural effusions and congenital chylothorax. In addition to our fetal care specialists, we have a variety of pediatric specialists such as newborn specialists and pediatric surgeons who will care for the baby once born.

We understand what it feels like to learn that your baby has a fetal condition and can help guide you through every step of your journey. Our fetal imaging specialists are experienced and trained in diagnosing conditions like this so you start with an accurate understanding of what your baby has. We boast some of the best fetal care success rates in the country so you have peace of mind in our care. And our care coordinators will help you with any ongoing care your baby may need and help you confidently prepare to take your baby home.