Download mild fetal pericardial effusion

ISRA MEDICAL JOURNAL
Volume 3 Issue 2 Aug 2011
CASE REPORT
MILD FETAL PERICARDIAL EFFUSION –
CLINICAL SIGNIFICANCE
Amjed Younas
ABSTRACT
Little amount of pericardial fluid may be considered normal. If thickness of pericardial fluid is more than this, it
may be associated with structural anomalies or hydrops fetalis. In a fetus if there are no associated findings,
mild pericardial effusion measuring two to seven mm in thickness should be considered normal.
KEY WORDS: Fetal pericardial effusion, pericardial fluid, fetal ultrasound.
INTRODUCTION
The pericardium consists of two sacs: the outer,
fibrous pericardium and the inner, serous or visceral
pericardium (epicardium). The proximal portions of
the aorta and pulmonary artery are enclosed within
the pericardial sac. The pericardium prevents friction
between the heart and surrounding structures, acts
as a mechanical and immunological barrier, and
limits distention of the heart, which maintains a
relatively fixed maximal heart volume. In normal
hearts, these functions are achieved by the presence
of a small amount of pericardial fluid (25-50 ml)
produced by the visceral pericardium. Inflammation
of the pericardial layers, with exudate owing to
increased production of pericardial fluid, is usually
caused by infection (viral causes are more common
than bacterial), but can also have a noninfectious
etiology 1,2.
CASE HISTORY
Young female patient came for routine checkup at 25
weeks gestation. On Ultrasound examination small
amount of pericardial fluid was observed. Its
thickness was about 2 mm. Umbilical cord was
around neck of fetus. It was not tight around neck as
there was a distance of few mm between the
umbilical cord and neck of fetus at various locations.
There was no other abnormal finding.
Fetus was active with normal growth. Amniotic fluid
was within normal limits and placenta was in upper
segment without any mass or hemorrhage. Spine of
fetus was also normal without any feature of
Correspondence to:
Dr. Amjed Younas
Assistant Professor Radiologist
Al-Nafees Medical College
Isra University, Islamabad Campus
Email: [email protected]
dysraphism. Stomach bubble was visible and there
were no features of esophageal atresia. Urinary
bladder contained urine, ventricular system in brain
was unremarkable and there was no mass effect or
midline shift.
DISCUSSION
Pericardial effusion can have many possible causes,
including infection such as viral, bacterial or
tuberculous, inflammatory disorders, such as lupus
and kidney failure with excessive blood levels of
nitrogen. The seriousness of the condition depends
on the primary cause and size of the effusion and
whether it can be treated effectively. The test most
commonly used to diagnose and evaluate fetal
pericardial effusion is Echocardiogram. Large
pericardial effusions may be drained through
Ultrasound-guided pericardiocentesis, a safe and
effective procedure to remove excess fluid from the
pericardium 3,4,5.
Prenatal sonographic identification of a small rim of
pericardial fluid, measuring less than 2 mm in
thickness, is a normal finding. Pericardial fluid 2 mm
or greater in thickness may be associated with
structural anomalies or hydrops, but its clinical
significance in the absence of these associated
findings has not been evaluated. We assessed the
outcome in fetuses with isolated pericardial effusions
of at least 2 mm thick6.
In a study on 52 fetuses with effusions ranging from 2
to 7 mm in thickness, we compared rates of preterm
delivery, cesarean section, intrauterine growth
retardation, perinatal complications, Apgar scores,
and length of neonatal hospital stay in these 52 cases
to the overall hospital rates and found no statistically
significant difference. We conclude that in the
absence of other sonographic abnormalities, the
finding of a fetal pericardial fluid collection 2 to 7 mm
in thickness is not associated with adverse outcome 6.
A study was carried out on forty-four fetuses with
pericardial effusions identified by ultrasonographic
69
examinations. The clinical histories and courses of
these patients were reviewed. At least eight different
clinical features accompanied and were probably
responsible for the pericardial effusions. The most
common cause of a fetal pericardial effusion was
heart failure (13 fetuses). Fetal renal cystic dysplasia
with oligohydramnios and other anomalies was
present in six fetuses. Four of this group had
microscopic evidence of pericarditis on postmortem
examination. Fetal pericardial effusions are always a
manifestation of another disease process often
presenting as fetal hydrops. Some pericardial
effusions are transient. The etiologic origin of fetal
pericardial effusions differs from that in the child or
adult7.
In our case umbilical cord was around neck of fetus,
but this is not associated with fetal pericardial
effusion, hence this additional finding was not
causing effusion.
There is no risk of preterm delivery or intrauterine
growth retardation in minimal pericardial effusion
having thickness equal to 2 mm.
In the absence of other fetal abnormalities, the finding
of a fetal pericardial fluid collection 2 mm in thickness
is not associated with adverse outcome8.
2.
3.
4.
5.
6.
7.
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