Images in Fetal Medicine Received: March 23, 2014 Accepted after revision: December 8, 2014 Published online: February 4, 2015
Fetal Diagn Ther DOI: 10.1159/000371513
Fetal MRI of Torsed Bronchopulmonary Sequestration with Tension Hydrothorax and Hydrops in a Twin Gestation Alan M. Coleman a Arnold C. Merrow b Timothy M. Crombleholme a Ronald Jaekle a Foong-Yen Lim a
Cincinnati Fetal Center, and b Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
Key Words Bronchopulmonary sequestration · Hybrid lesion · Hydrothorax · Fetal MRI · Prenatal MRI · Torsion · Laser photocoagulation
Abstract While bronchopulmonary sequestration typically has a benign course, this congenital lung malformation has a high mortality rate when associated with untreated in utero tension hydrothorax and hydrops. Hydrops related to bronchopulmonary sequestration is believed to result from torsion of the mass with compromise of the associated blood supply. The impaired venous return of the mass then leads to tension hydrothorax with compression of the heart and mediastinal vessels, impairing global venous return. To our knowledge, this scenario has only been described prenatally by ultrasound. We present the imaging findings of a dichorionic, diamniotic twin gestation with one fetus developing tension hydrothorax and hydrops from presumed intermittent torsion of a bronchopulmonary sequestration. This diagnosis was only able to be confirmed by MRI prior to the use of ultrasound-guided interstitial laser photocoagulation for the treatment of this anomaly. © 2015 S. Karger AG, Basel
© 2015 S. Karger AG, Basel 1015–3837/15/0000–0000$39.50/0 E-Mail [email protected] www.karger.com/fdt
Case Report A 30-year-old gravida 2, para 1 female was referred to our center for the evaluation of a dichorionic, diamniotic twin gestation complicated by a left pleural effusion in twin B, first diagnosed at 24 weeks’ gestation by ultrasound and suspected to represent a chylothorax. A subsequent ultrasound evaluation of twin B performed at our center at 25 weeks revealed polyhydramnios with a deepest vertical pocket of 11 cm (normal 2–8 cm), a large left-sided pleural effusion with mediastinal shifting, and abdominal ascites. No right-sided pleural effusion was seen. Twin A had no reported abnormalities and a normal deepest vertical pocket. Doppler studies were within normal limits for both fetuses. Thoracentesis was performed on twin B with removal of 100 ml of amber fluid. The analysis was negative for cytomegalovirus, parvovirus, toxoplasmosis, Epstein-Barr virus, chromosomal abnormality, and chylothorax (i.e. lymphocyte cell count
Fetal Diagn Ther DOI: 10.1159/000371513
Fetal MRI of Torsed Bronchopulmonary Sequestration with Tension Hydrothorax and Hydrops in a Twin Gestation Alan M. Coleman a Arnold C. Merrow b Timothy M. Crombleholme a Ronald Jaekle a Foong-Yen Lim a
Cincinnati Fetal Center, and b Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
Key Words Bronchopulmonary sequestration · Hybrid lesion · Hydrothorax · Fetal MRI · Prenatal MRI · Torsion · Laser photocoagulation
Abstract While bronchopulmonary sequestration typically has a benign course, this congenital lung malformation has a high mortality rate when associated with untreated in utero tension hydrothorax and hydrops. Hydrops related to bronchopulmonary sequestration is believed to result from torsion of the mass with compromise of the associated blood supply. The impaired venous return of the mass then leads to tension hydrothorax with compression of the heart and mediastinal vessels, impairing global venous return. To our knowledge, this scenario has only been described prenatally by ultrasound. We present the imaging findings of a dichorionic, diamniotic twin gestation with one fetus developing tension hydrothorax and hydrops from presumed intermittent torsion of a bronchopulmonary sequestration. This diagnosis was only able to be confirmed by MRI prior to the use of ultrasound-guided interstitial laser photocoagulation for the treatment of this anomaly. © 2015 S. Karger AG, Basel
© 2015 S. Karger AG, Basel 1015–3837/15/0000–0000$39.50/0 E-Mail [email protected] www.karger.com/fdt
Case Report A 30-year-old gravida 2, para 1 female was referred to our center for the evaluation of a dichorionic, diamniotic twin gestation complicated by a left pleural effusion in twin B, first diagnosed at 24 weeks’ gestation by ultrasound and suspected to represent a chylothorax. A subsequent ultrasound evaluation of twin B performed at our center at 25 weeks revealed polyhydramnios with a deepest vertical pocket of 11 cm (normal 2–8 cm), a large left-sided pleural effusion with mediastinal shifting, and abdominal ascites. No right-sided pleural effusion was seen. Twin A had no reported abnormalities and a normal deepest vertical pocket. Doppler studies were within normal limits for both fetuses. Thoracentesis was performed on twin B with removal of 100 ml of amber fluid. The analysis was negative for cytomegalovirus, parvovirus, toxoplasmosis, Epstein-Barr virus, chromosomal abnormality, and chylothorax (i.e. lymphocyte cell count
