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The x-ray has normal lung volumes. There are bilateral pleural effusions (more visible on the right side) and some secondary thickening of the minor fissure. Mild diffuse opacification of the lungs fields bilaterally with poor lung vascular markings. There is also a possibility of subpleural edema. A umbilical vein catheter and umbilical artery catheter are present.

NEONATAL PLEURAL EFFUISIONS (1)
Isolated pleural effusion occur in 1:10000 deliveries. Fetal hydrothorax is a diagnosis of exclusion.

The work-up includes: Detailed ultrasound to exclude other structural abnormalities, rule out other genetic syndromes, exclude congenital infection and chorioamnionitis.

Most fetal pleural effusions undergo spontaneous resolution. Approximately 5 - 10% resolve prenatally and between 30 - 5-% post-natally. If the pleural effusion persists, the neonate is at risk of significant fetal distress.

There are two primary mechanisms for this: Primary compression and secondary pulmonary hypoplasia. Non-immune fetal hydrops has a poor prognosis for respiratory distress post-natally. The cause of this is unclear. Some of the postulated mechanisms include: increased intrathoracic pressure; impaired blood flow in great vessels secodary to a mediastinal shift; loss of protein in the chylothorax with edema.

FURTHER HISTORY

A pleural effusion work-up was completed for our patient. A TORCH screen and parvovirus B19 serology were negative. The patient was rheumatoid factor negative and the chromosomes were normal. JB had normal liver enzymes and cardiac echo (normal anatomy, ventricular function, and no patent ductus) The only other associated findings were hypoalbuminemia (18 g) and hypoproteinia (35 g)

BELOW is the follow-up CHEST X-RAY later the same day.


ENLARGE this CHEST X-RAY.

WHAT HAS HAPPENED?


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