2003-01-14-15 Chylothorax drainage © Sosa www.thefetus.net/
Alberto Sosa. MD, PhD, Luis Diaz Guerrero, MD, Giugni Chalbaud, MD
Perinatology Unit, Carabobo University, Valencia – Venezuela
This is a 31-year-old primigest with an unremarkable pregnancy. At 15 weeks she has an amniocentesis for an elevated screening test for trisomy 21. A normal male karyotype is obtained.
At 27 weeks a left hydrothorax is visible but since there is no mediastinal shift we elected to observe her weekly. At 28 weeks the hydrothorax has increased and resulted in a mediastinal shift with dextrocardia. We performed a thoracocentesis, drained 50 cc of fluid and attempted a pleurodesis with intrapleural triamcinolone.
The analysis of the pleural fluid revealed 100% lymphocytes.
The pleural effusion recurred at 29 weeks, at which time a repeat tap with drainage of another 40cc was performed.
At 30 weeks we decided to place a thoraco-amniotic shunt (double pigtail Harrison shunt). Shunt placement and function were satisfactory. Doppler indices of pulmonary resistance progressively decreased.
At 39 weeks the shunt migrated into the thorax, and an elective cesarean section was performed. The Apgars were 9 & 10.
The postnatal evolution of the baby was unremarkable. The X-ray confirmed the intrathoracic location of the shunt.