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.

• Authors: C Jeanty, J K Nien, J Espinoza, J P Kusanovic, L F Gonçalves, F Qureshi, S Jacques, W Lee, R Romero
• Journal: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology (Ultrasound Obstet Gynecol) Vol. 29 Issue 4 Pg. 378-87 (Apr 2007) ISSN: 0960-7692 [Print] England
• PMID: 17366518 (Publication Type: Case Reports, Journal Article, Research Support, N.I.H., Intramural, Review)
• Copyright: Copyright (c) 2007 ISUOG.

Topics

• Adult
• Diagnosis, Differential
• Diaphragmatic Eventration (complications, diagnostic imaging)
• Female
• Fetal Diseases (diagnostic imaging)
• Hernia, Diaphragmatic (complications, diagnostic imaging)
• Hernias, Diaphragmatic, Congenital
• Humans
• Pericardial Effusion (diagnostic imaging, etiology)
• Pleural Effusion (diagnostic imaging, etiology)
• Pregnancy
• Ultrasonography, Prenatal