eMedicine Specialties > Radiology > Obstetrics/Gynecology
Hydrops Fetalis: Imaging
Updated: Jul 16, 2008
Radiography
Findings
Plain radiograph of the chest and abdomen of a neonate. This image shows a markedly distended abdomen with centrally located bowel loops that are suggestive of ascites. The soft tissues are edematous although the lung fields are clear.
Antenatal radiography has no place in the diagnosis of fetal hydrops because this condition is essentially a disease of the soft tissue and because of the reservations regarding using radiography in pregnant women.
Computed Tomography
Findings
Computed tomography (CT) scans may offer better anatomic resolution, but CT scans are difficult to obtain in the presence of an active fetus, and radiation exposure in pregnant women is a concern.
Magnetic Resonance Imaging
Findings
Exquisite anatomic detail can be depicted on magnetic resonance images (MRIs), especially on those obtained with newer algorithms that allow fast acquisitions and that minimize the effect of fetal movement. However, MRI has not become a standard modality for imaging fetal hydrops because of the limited availability of state-of-the-art equipment for fast imaging and because of the expense involved. In addition, ultrasonography is widely available and can adequately provide most of the required information. These factors have hindered a wider use of MRI in fetal imaging.
Early detection of cerebral damage in a fetus associated with hydrops and cytomegalovirus infection is possible with fetal MRI. Salmaso et al described a case of a woman presenting at 21 weeks of pregnancy with active CMV infection.22 Although a cerebral ultrasound examination had been normal, an MRI scan revealed a thickened germinal matrix, which was histologically confirmed and which was associated with underdevelopment of the gyri.
Ultrasonography
Findings
Ultrasonography remains the cornerstone of fetal imaging in fetuses in whom hydrops fetalis is suspected. Sonograms demonstrate the cardinal signs of the disease, namely, fetal skin edema (>5 mm) (see Images below and Images 5-7 and 11 in Multimedia), fluid in a serous cavity, polyhydramnios, and a thickened placenta. These signs can be seen in different combinations and to differing extents in various diseases.23 Additional findings, depending on the specific etiology causing the fetal hydrops, are occasionally seen as well.
Sonogram depicting gross skin edema involving the legs. The asterisks indicate edema of the lower ends of the thighs. F = femur.
Left: Transverse section of the fetal abdomen. Right: Coronal section of the fetal thorax. These sonograms show ascites (asterisk) and echogenic lungs (L). This fetus had tracheal atresia. The red arrows indicate skin edema.
Transverse sections of the fetal abdomen. These sonograms show small ascites (asterisk) and gross skin edema (red arrows).
Transverse ultrasonographic sections of the head (left) and chest (right) of a fetus with hydrops fetalis. Note the halo around the head; this is due to edema. Compare the halo with pseudoedema due to fetal hair. The chest shows gross skin edema and a large, bilateral pleural collection.
The minimum diagnostic criteria include the following: fluid accumulation in at least 2 serous cavities (ascites, pleural effusion, or pericardial effusion) or 1 serous effusion and generalized anasarca. A single site of fluid accumulation is generally not enough to diagnose hydrops fetalis unless a preexisting pathology that is strongly associated with this condition (eg, chest mass) is also present.
False Positives/Negatives
A few conditions mimic full-blown hydrops fetalis, but individual components of hydrops fetalis can be seen in other conditions, even as normal variants.
Normal fetal hair and a thick scalp can occasionally be seen, and this finding must be differentiated from skin edema (see Images below and Images 8-9 and 11 in Multimedia). Similarly, cystic hygromas and loops of cord near the body wall can suggest skin thickening. Occasionally, a thick layer of subcutaneous fat may cause confusion.
Sonogram depicting crocodile skin in a fetus. This condition is a normal finding in some fetuses; the folded, apparently thickened skin (red arrows) can be confused with skin edema.
Transverse sonogram of a normal fetal head. The hair is visible as an irregular halo and can cause confusion with scalp edema.
Thick, folded skin, occasionally termed crocodile skin, is a normal variant that can cause confusion with skin edema (see Image 8).
A congenital cystic adenomatoid malformation of the lung, a diaphragmatic hernia, and a bronchogenic cyst can suggest pleural effusions.
Pseudoascites, obstructed or mature bowel, fetal abdominal cysts, and an obstructed urinary system can mimic ascites. Pseudoascites refers to an artifactual hypoechoic rim that is sometimes seen in the fetal abdomen; this is due to hypoechoic, deep abdominal wall muscles or the diaphragm. Pseudoascites usually disappears when scanning is performed from another direction. Other features that differentiate pseudoascites from ascites are as follows: (1) Pseudoascites is not seen past the anterior edge of the ribs; (2) pseudoascites is confined to the upper abdomen, unlike ascites, which is diffuse; and (3) With ascites, the hyperechoic outer margin of the umbilical vein can be seen, as can the falciform ligament.
A small pericardial effusion (<2 mm) is usually physiologic.
Nuclear Imaging
Findings
No role exists for nuclear medicine in the workup of patients with fetal hydrops.
Angiography
Findings
No role exists for angiography in the workup of patients with fetal hydrops.
More on Hydrops Fetalis |
| Overview: Hydrops Fetalis |
 Imaging: Hydrops Fetalis |
| Follow-up: Hydrops Fetalis |
| Multimedia: Hydrops Fetalis |
| References |
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References
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Further Reading
Keywords
hydrops fetalis, fetal hydrops, edema of the fetus, nonimmune hydrops erythroblastosis fetalis, universal edema of the newborn, neonatal edema, fetal edema, immune hydrops fetalis, IHF, immune-related hydrops fetalis, nonimmune hydrops fetalis, NIHF, nonimmune-related hydrops fetalis, crocodile skin, α thalassemia, alpha thalassemia
