HDlive Flow with HDlive Silhouette Feature of Isolated Fetal Pericardial Effusion at 17 Weeks of Gestation

Toshiyuki Hata¹, Aya Koyanagi², Miyu Konishi³, Takahito Miyake⁴

^1,4Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan; Department of Perinatology and Gynecology, Graduate School of Medicine, Kagawa University, Kagawa, Japan

^2,3Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan

Corresponding Author: Toshiyuki Hata, Department of Obstetrics and Gynecology, Miyake Clinic, Okayama, Japan; Department of Perinatology and Gynecology, Graduate School of Medicine, Kagawa University, Kagawa, Japan, Phone: +810878912174, e-mail: toshi28@med.kagawa-u.ac.jp

ABSTRACT

Objective: To present HDlive Flow with spatiotemporal image correlation (STIC) and HDlive Silhouette features of isolated fetal pericardial effusion (IFPE) detected at 17 weeks and 4 days of gestation. Case description: Two-dimensional sonography showed a sickle-shaped echo-free space (5.6 mm) located along the right-side of the fetal heart (atrioventricular groove) at 17 weeks and 4 days of gestation. Radiant flow revealed no flow inside the cyst. HDlive Flow and HDlive Silhouette clearly depicted the spatial relationship between a tadpole-shaped echo-free space and the fetal heart. The cyst disappeared at 24 weeks and 5 days of gestation. A healthy male neonate was delivered at 40 weeks and 4 days, and had no complications. There was no developmental or neurological disorder of the baby one year after birth. Conclusion: HDlive Silhouette may provide information on the spatial recognition and origin of an echo-free space of the fetus.

How to cite this article: Hata T, Koyanagi A, Konishi M, et al. HDlive Flow with HDlive Silhouette Feature of Isolated Fetal Pericardial Effusion at 17 Weeks of Gestation. Donald School J Ultrasound Obstet Gynecol 2023;17(3):181–183.

Source of support: Nil

Conflict of interest: Dr Toshiyuki Hata is associated as the Scientific Editor of this journal and this manuscript was subjected to this journal’s standard review procedures, with this peer review handled independently of this Scientific Editor and his research group.

Keywords: HDlive Flow, HDlive Silhouette, Isolated fetal pericardial effusion, Radiant flow

INTRODUCTION

The limit value of normal fetal pericardial effusion is <2 mm in thickness.¹ The clinical significance of isolated fetal pericardial effusion (IFPE) is inconsistent. Di Salvo et al.² reported that IFPE was not associated with adverse outcomes. Sharland and Lockhart³ reported that there was a high incidence of associated chromosomal abnormalities, particularly trisomy 21, in cases with IFPE. Azancot et al.⁴ showed that IFPE covered a wide spectrum of etiologies, from severe genetic and chromosomal diseases to transient forms. Hidalgo Sanz et al.⁵ reported that the overall morbidity rate in IFPE patients was 34.2%, and the death rate was 15.7%. Therefore, close pre and postnatal follow-ups of IFPE cases are mandatory to conduct early intervention.

HDlive Silhouette could clearly show fetal cardiac structures and intrathoracic and intra-abdominal echo-free structures.⁶^,⁸ HDlive Flow could also clearly demonstrate a normal fetal heart and congenital heart anomalies in utero.⁹^,¹² In this report, we present HDlive Flow with spatiotemporal image correlation (STIC) and HDlive Silhouette features of IFPE detected at 17 weeks and 4 days of gestation.

CASE DESCRIPTION

A 39-year-old pregnant Japanese woman, gravida 1, para 0, received a routine obstetric examination at 17 weeks and 4 days of gestation, and two-dimensional sonography showed a sickle-shaped echo-free space (5.6 mm) located along the right side of the fetal heart (atrioventricular groove) (Fig. 1). Radiant flow revealed no flow inside the cyst (Fig. 2). HDlive Flow and HDlive Silhouette (Voluson E10 BT21, GE Healthcare, Zipf, Austria) clearly depicted a spatial relationship between a tadpole-shaped echo-free space and the fetal heart (Fig. 3). The cyst disappeared at 24 weeks and 5 days of gestation.

Fig. 1: Two-dimensional sonographic image of IFPE (arrow) at 17 weeks and 4 days of gestation; LV, left ventricle; RA, right atrium; RV, right ventricle

Fig. 2: Radiant flow image of IFPE (arrow) at 17 weeks and 4 days of gestation; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle

Fig. 3: HDlive Flow and HDlive Silhouette image of IFPE (arrows) at 17 weeks and 4 days of gestation; LV, left ventricle; RV, right ventricle

At 40 weeks and 4 days of gestation, the mother delivered a viable male newborn weighing 2872 gm, with a height of 49 cm. The Apgar scores were 9 (1 min) and 9 (5 min), and the umbilical artery blood pH was 7.11. The mother and neonate followed favorable courses after delivery. There was no developmental or neurological disorder in the baby 1 year after birth.

DISCUSSION

HDlive Flow and HDlive Silhouette can provide unique information for spatial recognition between vascular and surrounding echo-free structures.¹³^-¹⁵ In the present case, a tadpole-shaped echo-free space (IFPE) and the fetal heart could be clearly identified using this technique. HDlive Flow and HDlive Silhouette may provide additional information on the spatial recognition and origin of IFPE.

Isolated fetal pericardial effusion (IFPE) is typically localized to one area (e.g., atrioventricular groove, left or right ventricle, apex) or occasionally two contiguous sites, but no reported case completely surrounded the heart.² In the present case, IFPE was located on the right atrioventricular groove. Moreover, two-thirds of IFPE reportedly resolved 1–9 weeks later.² IFEPs, in our case, were also resolved 7 weeks later. Therefore, IFPE may be a transient phenomenon during pregnancy. However, a high incidence of genetic and chromosomal diseases was associated with IFPE.³^-⁵ Close pre and postnatal follow-ups of IFPE cases may be mandatory to conduct early intervention.

REFERENCES

1. Jeanty P, Romero R, Hobbins JC. Fetal pericardial fluid: a normal finding of the second half of gestation. Am J Obstet Gynecol 1984;149(5):529–532. DOI: 10.1016/0002-9378(84)90030-9

2. Di Salvo DN, Brown DL, Doubilet PM, et al. Clinical significance of isolated fetal pericardial effusion. J Ultrasound Med 1994;13(4):291–293. DOI: 10.7863/jum.1994.13.4.291

3. Sharland G, Lockhart S. Isolated pericardial effusion: an indication for fetal karyotyping? Ultrasound Obstet Gynecol 1995;6(1):29–32. DOI: 10.1046/j.1469-0705.1995.06010029.x

4. Azancot A, Diehl R, Dorgeret S, et al. Isolated pericardial effusion in the human fetus: a report of three cases. Prenat Diagn 2003;23(3):193–197. DOI: 10.1002/pd.563

5. Hidalgo Sanz J, Fernández Ventureira V, Palanca Arias D, et al. Isolated fetal pericardial effusion follow-up: should we worry? An Pediatr 2022;96(4):342–348. DOI: 10.1016/j.anpede.2021.02.013

6. AboEllail MAM, Kanenishi K, Marumo G, et al. Fetal HDlive silhouette mode in clinical practice. Donald School J Ultrasound Obstet Gynecol 2015;9(4):413–419. DOI: 10.5005/jp-journals-10009-1428

7. AboEllail MAM, Tanaka H, Mori N, et al. HDlive Silhouette mode in antenatal diagnosis of jejunal atresia. Ultrasound Obstet Gynecol 2016;48(1):131–132. DOI: 10.1002/uog.15737

8. Hata T, AboEllail MAM, Sajapala S, et al. HDlive Silhouette mode with spatiotemporal correlation in assessment of the fetal heart. J Ultrasound Med 2016;35(7):1489–1495. DOI: 10.7863/ultra.15.08061

9. Ito M, AboEllail MAM, Yamamoto K, et al. HDlive Flow silhouette mode and spatiotemporal image correlation for diagnosing congenital heart disease. Ultrasound Obstet Gynecol 2017;50(3):411–415. DOI: 10.1002/uog.17519

10. AboEllail MAM, Kanenishi K, Tenkumo C, et al. Four-dimensional power Doppler sonography with the HDlive silhouette mode in antenatal diagnosis of a right aortic arch with an aberrant left subclavian artery. J Ultrasound Med 2016;35(3):661–663. DOI: 10.7863/ultra.15.05047

11. Hata T, Ito M, Nitta E, et al. HDlive Flow silhouette mode for diagnosis of ectopia cordis with a left ventricular diverticulum at 15 weeks’ gestation. J Ultrasound Med 2018;37(10):2465–2467. DOI: 10.1002/jum.14583

12. Hata T, Koyanagi A, Yamanishi T, et al. Three-dimensional fetal echocardiographic assessment of persistent left superior vena cava with absent right superior vena cava. Donald School J Ultrasound Obstet Gynecol 2020;14(4):346–348. DOI: 10.5005/jp-journals-10009-1671

13. Tenkumo C, Hanaoka U, AboEllail MAM, et al. HDlive Flow with HDlive silhouette mode in diagnosis of fetal hepatic hemangioma. Ultrasound Obstet Gynecol 2017;49(4):540–545. DOI: 10.1002/uog.16215

14. Hata T, Kawahara T, Konishi M, et al. Three-vessel trachea view of fetal vascular ring: HDlive Flow with STIC and HDlive (silhouette) study. Donald School Ultrasound Obstet Gynecol 2023;17(1):1–4. DOI: 10.5005/jp-journals-10009-1965

15. Hata T, Koyanagi A, Kawahara T, et al. Fetal intrathoracic cyst at 9 weeks of gestation. Donald School J Ultrasound Obstet Gynecol 2023;17(2):121–123. DOI: 10.5005/jp-journals-10009-1967

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