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Radiology
Hydrothorax
Built from Obstetric Imaging
What’s inside
10 sections · 78 slides
Overview
- What this session covers
Fluid in the fetal chest
What hydrothorax is, what to call it, and how often it happens
- Start with the picture, not the word
- Fluid in the pleural space
- The formal definition
- Two names, two moments in time
- Why "chylothorax" belongs to the newborn
- Chyle drained from a chylothorax
- The plumbing behind it
- 1 in 8600
- Reading those numbers
Why the fluid is there
Hydrothorax as a sign of something else, and the causes that must be excluded
- A sign, not a diagnosis
- Where the causes come from
- The two biggest groups
- Chromosomes and blood
- Newborn with generalised swelling from hydrops
- Infections that can cause it
- The remaining causes
- Primary hydrothorax: a diagnosis of exclusion
- Primary or secondary?
- Why the direction of causation blurs
What the trapped fluid does
Lung hypoplasia, hydrops and polyhydramnios — the three consequences
- Two consequences that matter most
- From fluid to failure
- Why the lung never grows
- Why the heart suffers
- The third consequence: too much amniotic fluid
- One squeeze, three problems
The work-up
What must be looked for once fluid is found
- The finding demands a search
- When standard tests come back normal
- What to say to the parents
How it presents
Isolated effusion, hydrops first, and the signs that predict a bad outcome
- Two ways it comes to attention
- The course of a mild effusion is hard to predict
- The signs that predict trouble
- The worry that outlasts the pregnancy
What you see on the scan
Ultrasound findings, grading severity, MRI, and the one real mimic
- The core ultrasound finding
- How a severe effusion looks
- Grading it: mild, moderate or severe
- Grading depends on the eye, not a number
- Fluid on the right side of the chest
- Fluid on the left side of the chest
- Fluid on both sides in a hydropic fetus
- One side versus both sides
- A trap worth naming
- Where MRI fits
- The one real look-alike
- Telling the two apart
Treatment before birth
Who to treat, how, and what the numbers really are
- Some cases need nothing at all
- Who is offered fetal therapy
- Decide before you drain
- The hardest call: a hydropic fetus
- Step one: a single tap
- Why one tap is not enough
- Pleuroamniotic shunting
- The treatment pathway
- >90%
- Reading the mortality figures
- Why mortality stays high after treatment
- What a large recent series found
- A different approach: sealing the space
- What OK-432 has achieved so far
- Two routes to a decompressed chest
- When the diagnosis comes very late
- An honest caveat on that plan
After the baby is born
Immediate care, confirming the diagnosis, and postnatal management
- The first minutes
- Confirm what you suspected
- Bilateral pleural fluid on a chest radiograph
- Managing the isolated case
- When the effusion will not settle
- The postnatal ladder
Taking it away
What the referring physician needs to know, and the key points
- What the referring physician needs to know
- Key points
- If you remember only five things
- References
- References (continued)
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- References (continued)
- Suggested reading
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition