Pleural and pericardial effusion: a potential ultrasonographic marker for the prenatal differential diagnosis between congenital diaphragmatic eventration and congenital diaphragmatic hernia

Abstract

Objectives: To determine whether or not the presence of pleural and/or pericardial effusion can be used prenatally as an ultrasonographic marker for the differential diagnosis between diaphragmatic eventration and diaphragmatic hernia.

Methods: We present two case reports of non-isolated diaphragmatic eventration associated with pleural and/or pericardial effusion. Additionally, we reviewed the literature for all cases of congenital diaphragmatic hernia (CDH) and diaphragmatic eventration that met the following criteria: (1) prenatal diagnosis of a diaphragmatic defect and (2) definitive diagnosis by autopsy or surgery. The frequencies of pleural effusion, pericardial effusion and hydrops were compared between the two conditions using Fisher's exact test. A subanalysis was conducted of cases with isolated diaphragmatic defects (i.e. diaphragmatic defects not associated with hydrops and other major structural or chromosomal anomalies).

Results: A higher proportion of fetuses with diaphragmatic eventration had associated pleural and pericardial effusions compared with fetuses with diaphragmatic hernia (58% (7/12) vs. 3.7% (14/382), respectively, P < 0.001). This observation remained true when only cases of diaphragmatic defects not associated with hydrops and other major structural or chromosomal anomalies were compared (29% (2/7) with eventration vs. 2.2% (4/178) with CDH, P < 0.02).

Conclusions: The presence of pleural and/or pericardial effusion in patients with diaphragmatic defects should raise the possibility of a congenital diaphragmatic eventration. This information is clinically important for management and counseling because the prognosis and treatment for CDH and congenital diaphragmatic eventration are different. Published by John Wiley & Sons, Ltd.

Figure 1

Ultrasound image showing a transverse section through the fetal chest at 22 weeks’ gestation. A mass is visualized on the right side of the thorax, displacing the heart to the left side. Bilateral pleural effusion is observed.

Figure 2

(a) Ultrasound image showing a right parasaggital section through the fetal thorax and abdomen. A mass with echotexture similar to that of the fetal liver is visualized protruding from the fetal abdomen into the thorax. (b) Power Doppler demonstrates vessels within the mass that connect to hepatic vessels, suggesting that the mass is indeed composed of liver tissue.

Figure 2

(a) Ultrasound image showing a right parasaggital section through the fetal thorax and abdomen. A mass with echotexture similar to that of the fetal liver is visualized protruding from the fetal abdomen into the thorax. (b) Power Doppler demonstrates vessels within the mass that connect to hepatic vessels, suggesting that the mass is indeed composed of liver tissue.

Figure 3

Anteroposterior view of a three-dimensional ultrasound rendered image of the fetal thorax and abdomen, demonstrating diaphragmatic Eventration (left) and correlation with autopsy findings (right).

Figure 4

(a) Coronal ultrasound image through the fetal thorax and abdomen. A mass is visualized protruding into the fetal chest from the fetal abdomen. The echotexture is similar to that of the liver. (b) Hepatic blood vessel extending from the abdomen to the thorax, confirming that the liver has herniated through the defect.

Figure 4

(a) Coronal ultrasound image through the fetal thorax and abdomen. A mass is visualized protruding into the fetal chest from the fetal abdomen. The echotexture is similar to that of the liver. (b) Hepatic blood vessel extending from the abdomen to the thorax, confirming that the liver has herniated through the defect.

Figure 5

Anteroposterior view of a three-dimensional ultrasound rendered image of the fetal thorax and abdomen, demonstrating diaphragmatic eventration (left) and correlation with autopsy (right).