Fetal hemothorax due to intrapleural rupture of a small anterior thoracic lymphatic malformation: a case report.
Haruna Kawaguchi, Katsuya Hirata, Wakako Ichida et al.
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Case in brief
A pregnant woman was referred at 26 weeks after bloody fetal pleural fluid was obtained by thoracentesis. Ultrasound showed right pleural effusion and a small, avascular heterogeneous area in the anterior chest wall; MRI characterized the fluid as hemothorax and the lesion as suggestive of a lymphatic malformation. With worsening hydrops and concern that shunting could provoke rebleeding and fetal anemia, delivery was undertaken. The newborn received intubation, chest drainage, and transfusion. Imaging confirmed a chest-wall lymphatic malformation extending toward the mediastinum; it regressed spontaneously without lesion-directed treatment. Neurodevelopment was normal at 18 months’ corrected age.
What made this case unusual
A small anterior chest-wall lymphatic malformation was suspected to have ruptured into the pleural space, causing fetal hemothorax and progressive hydrops—an atypical presentation of a benign lesion.
Diagnostic / clinical pearl
When fetal pleural effusion is hemorrhagic, MRI can help characterize the fluid and identify a small associated chest-wall lesion that may be inconspicuous on ultrasound.
Why it matters
The case illustrates that, when fetal hemothorax raises concern about rebleeding with shunting, delivery followed by neonatal management may be considered; the reported lesion also regressed without surgery or sclerotherapy.