eMedicine Specialties > Radiology > Obstetrics/Gynecology

Hydrops Fetalis: Multimedia

Author: Durre Sabih, MBBS, MSc, Visiting Faculty, Department of Nuclear Medicine, Pakistan Institute Applied Sciences and Nishtar Medical College; Director, Multan Institute of Nuclear Medicine and Radiotherapy
Coauthor(s): Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia; Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute; Zahida Sabih, MBBS, MSc,
Contributor Information and Disclosures

Updated: Jul 16, 2008

Multimedia

Coronal (<I>left</I>) and axial (<I>right</I>) fe...
(Enlarge Image)
Media file 1: Coronal (left) and axial (right) fetal sonograms obtained late in the second trimester (same patient in Images 1-4). These images show a large pleural effusion. The parents were from the Far East, and an earlier pregnancy had ended because of α thalassemia, which is a major cause of nonimmune-related hydrops fetalis in the Far East. The condition is uniformly fatal and associated with a significant risk of maternal morbidity. The α thalassemia gene is found in 20-30% of the population in Southeast Asia. The fetus was lost within 1 week of the ultrasonographic examination. Eff. = effusion; F. liver = fetal liver.
[ CLOSE WINDOW ]
Coronal (<I>left</I>) and axial (<I>right</I>) fe...

Coronal (left) and axial (right) fetal sonograms obtained late in the second trimester (same patient in Images 1-4). These images show a large pleural effusion. The parents were from the Far East, and an earlier pregnancy had ended because of α thalassemia, which is a major cause of nonimmune-related hydrops fetalis in the Far East. The condition is uniformly fatal and associated with a significant risk of maternal morbidity. The α thalassemia gene is found in 20-30% of the population in Southeast Asia. The fetus was lost within 1 week of the ultrasonographic examination. Eff. = effusion; F. liver = fetal liver.

Coronal sonograms show a collapsed lung (<I>arrow...
(Enlarge Image)
Media file 2: Coronal sonograms show a collapsed lung (arrows) as a result of a large pleural effusion (same patient in Images 1-4).
[ CLOSE WINDOW ]
Coronal sonograms show a collapsed lung (<I>arrow...

Coronal sonograms show a collapsed lung (arrows) as a result of a large pleural effusion (same patient in Images 1-4).

Sonograms show scalp edema (<I>S</I>) (<I>left</I...
(Enlarge Image)
Media file 3: Sonograms show scalp edema (S) (left) and edema of the thoracic wall (T) (right) (same patient in Images 1-4).
[ CLOSE WINDOW ]
Sonograms show scalp edema (<I>S</I>) (<I>left</I...

Sonograms show scalp edema (S) (left) and edema of the thoracic wall (T) (right) (same patient in Images 1-4).

Sonograms shows limb edema (<i>L</i>) (<i>left</i...
(Enlarge Image)
Media file 4: Sonograms shows limb edema (L) (left) and thoracic wall edema (T) (right) (same patient in Images 1-4).
[ CLOSE WINDOW ]
Sonograms shows limb edema (<i>L</i>) (<i>left</i...

Sonograms shows limb edema (L) (left) and thoracic wall edema (T) (right) (same patient in Images 1-4).

Sonogram depicting gross skin edema involving the...
(Enlarge Image)
Media file 5: Sonogram depicting gross skin edema involving the legs. The asterisks indicate edema of the lower ends of the thighs. F = femur.
[ CLOSE WINDOW ]
Sonogram depicting gross skin edema involving the...

Sonogram depicting gross skin edema involving the legs. The asterisks indicate edema of the lower ends of the thighs. F = femur.

<I>Left:</I> Transverse section of the fetal abdo...
(Enlarge Image)
Media file 6: 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.
[ CLOSE WINDOW ]
<I>Left:</I> Transverse section of the fetal abdo...

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 s...
(Enlarge Image)
Media file 7: Transverse sections of the fetal abdomen. These sonograms show small ascites (asterisk) and gross skin edema (red arrows).
[ CLOSE WINDOW ]
Transverse sections of the fetal abdomen. These s...

Transverse sections of the fetal abdomen. These sonograms show small ascites (asterisk) and gross skin edema (red arrows).

Sonogram depicting crocodile skin in a fetus. Thi...
(Enlarge Image)
Media file 8: 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.
[ CLOSE WINDOW ]
Sonogram depicting crocodile skin in a fetus. Thi...

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 h...
(Enlarge Image)
Media file 9: Transverse sonogram of a normal fetal head. The hair is visible as an irregular halo and can cause confusion with scalp edema.
[ CLOSE WINDOW ]
Transverse sonogram of a normal fetal head. The h...

Transverse sonogram of a normal fetal head. The hair is visible as an irregular halo and can cause confusion with scalp edema.

Plain radiograph of the chest and abdomen of a ne...
(Enlarge Image)
Media file 10: 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.
[ CLOSE WINDOW ]
Plain radiograph of the chest and abdomen of a ne...

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.

Transverse ultrasonographic sections of the head ...
(Enlarge Image)
Media file 11: 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.
[ CLOSE WINDOW ]
Transverse ultrasonographic sections of the head ...

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.

More on Hydrops Fetalis

Overview: Hydrops Fetalis
Imaging: Hydrops Fetalis
Follow-up: Hydrops Fetalis
Multimedia: Hydrops Fetalis
References
[ CLOSE WINDOW ]

References

  1. Tercanli S, Gembruch U, Holgreve W. Nonimmune hydrops fetalis: diagnosis and management. In: Callan P, ed. Ultrasonography in Obstetrics and Gynecology. 4th ed. Philadelphia, Pa: WB Saunders Co; 2000:551-75.

  2. Benacerraf BR. Hydrops. Ultrasound in Fetal Syndrome. New York, NY: Churchill Livingstone; 1998:73.

  3. Challis DE, Ryan G, Jefferies A. Fetal hydrops. In: Rumack CM, Wilson SR, Charboneau JW, eds. Diagnostic Ultrasound. St Louis, Mo: Mosby-Year Book; 1998:1303-22.

  4. Sauerbrel E, Nguyen KT, Nolan RL. Fetal hydrops. A Practical Guide to Ultrasound in Obstetrics and Gynecology. 2nd ed. Philadelphia, Pa: Lippincott-Raven; 1998:377-83.

  5. Bisset RA, Khan AN, Thomas NB. Causes of fetal hydrothorax. Differential Diagnosis in Obstetric and Gynecologic Ultrasound. Philadelphia, Pa: WB Saunders; 1997:216-9.

  6. Williams IA, Kleinman CS. Is hydrops fetalis a manifestation of fetal pulmonary edema caused by impaired lymphatic drainage?. Ultrasound Obstet Gynecol. Jan 2008;31(1):96-9. [Medline].

  7. Api O, Carvalho JS. Fetal dysrhythmias. Best Pract Res Clin Obstet Gynaecol. Feb 2008;22(1):31-48. [Medline].

  8. Hirsch M, Friedman S, Schoenfeld A, Ovadia J. Nonimmune hydrops fetalis--a rational attitude of management. Eur J Obstet Gynecol Reprod Biol. Mar 1985;19(3):191-6. [Medline].

  9. Holzgreve W, Curry CJ, Golbus MS, et al. Investigation of nonimmune hydrops fetalis. Am J Obstet Gynecol. Dec 1 1984;150(7):805-12. [Medline].

  10. Sahn DJ, Shenker L, Reed KL, et al. Prenatal ultrasound diagnosis of hypoplastic left heart syndrome in utero associated with hydrops fetalis. Am Heart J. Dec 1982;104(6):1368-72. [Medline].

  11. Sohan K, Carroll S, Byrne D, Ashworth M, Soothill P. Parvovirus as a differential diagnosis of hydrops fetalis in the first trimester. Fetal Diagn Ther. Jul-Aug 2000;15(4):234-6. [Medline].

  12. Moxley K, Knudtson EJ. Resolution of hydrops secondary to cytomegalovirus after maternal and fetal treatment with human cytomegalovirus hyperimmune globulin. Obstet Gynecol. Feb 2008;111(2 pt 2):524-6. [Medline].

  13. Spear GS, Beutler E, Hungs M. Congenital Gaucher disease with nonimmune hydrops/erythroblastosis, infantile arterial calcification, and neonatal hepatitis/fibrosis. Clinicopathologic report with enzymatic and genetic analysis. Fetal Pediatr Pathol. May-Jun 2007;26(3):153-68. [Medline].

  14. Oudesluys-Murphy AM. Nonimmune hydrops fetalis in Noonan's syndrome. Am J Dis Child. May 1987;141(5):478-9. [Medline].

  15. Yanai N, Shveiky D. Fetal hydrops, associated with maternal propylthiouracil exposure, reversed by intrauterine therapy. Ultrasound Obstet Gynecol. Feb 2004;23(2):198-201. [Medline].

  16. Has R. Non-immune hydrops fetalis in the first trimester: a review of 30 cases. Clin Exp Obstet Gynecol. 2001;28(3):187-90. [Medline].

  17. Heinonen S, Ryynänen M, Kirkinen P. Etiology and outcome of second trimester non-immunologic fetal hydrops. Acta Obstet Gynecol Scand. Jan 2000;79(1):15-8. [Medline].

  18. Bukowski R, Saade GR. Hydrops fetalis. Clin Perinatol. Dec 2000;27(4):1007-31. [Medline].

  19. Vautier-Rit S, Dufour P, Vaksmann G, et al. [Fetal arrhythmias: diagnosis, prognosis, treatment; apropos of 33 cases] [French]. Gynecol Obstet Fertil. Oct 2000;28(10):729-37. [Medline].

  20. Castillo RA, Devoe LD, Hadi HA, Martin S, Geist D. Nonimmune hydrops fetalis: clinical experience and factors related to a poor outcome. Am J Obstet Gynecol. Oct 1986;155(4):812-6. [Medline].

  21. Harper A, Kenny B, O'Hara MD, Nelson J. Recurrent idiopathic non-immunologic hydrops fetalis: a report of two families, with three and two affected siblings. Br J Obstet Gynaecol. Aug 1993;100(8):796. [Medline].

  22. Salmaso R, Franco R, de Santis M, et al. Early detection by magnetic resonance imaging of fetal cerebral damage in a fetus with hydrops and cytomegalovirus infection. J Matern Fetal Neonatal Med. Jul 2007;20(7):559-61. [Medline].

  23. Favre R, Dreux S, Dommergues M, et al. Nonimmune fetal ascites: a series of 79 cases. Am J Obstet Gynecol. Feb 2004;190(2):407-12. [Medline].

  24. Hsieh FJ, Chang FM, Ko TM, Chen HY. Percutaneous ultrasound-guided fetal blood sampling in the management of nonimmune hydrops fetalis. Am J Obstet Gynecol. Jul 1987;157(1):44-9. [Medline].

  25. Harman CR, Bowman JM, Manning FA, Menticoglou SM. Intrauterine transfusion--intraperitoneal versus intravascular approach: a case-control comparison. Am J Obstet Gynecol. Apr 1990;162(4):1053-9. [Medline].

  26. Harris JP, Alexson CG, Manning JA, Thompson HO. Medical therapy for the hydropic fetus with congenital complete atrioventricular block. Am J Perinatol. May 1993;10(3):217-9. [Medline].

  27. Gembruch U, Manz M, Bald R, et al. Repeated intravascular treatment with amiodarone in a fetus with refractory supraventricular tachycardia and hydrops fetalis. Am Heart J. Dec 1989;118(6):1335-8. [Medline].

  28. Greco P, Vimercati A, Giorgino F, Loverro G, Selvaggi L. Reversal of foetal hydrops and foetal tachyarrhythmia associated with maternal diabetic coma. Eur J Obstet Gynecol Reprod Biol. Nov 2000;93(1):33-5. [Medline].

  29. Walsh DS, Adzick NS. Fetal surgical intervention. Am J Perinatol. 2000;17(6):277-83. [Medline].

  30. Castellino SM, Powers R, Kalwinsky D, DeVoe M. Abdominal rhabdoid tumor presenting as fetal hydrops: a case report. J Pediatr Hematol Oncol. May 2001;23(4):258-9. [Medline].

  31. Harman CR, Manning FA, Bowman JM, Lange IR, Menticoglou SM. Use of intravascular transfusion to treat hydrops fetalis in a moribund fetus. CMAJ. May 1 1988;138(9):827-30. [Medline]. [Full Text].

  32. Turski DM, Shahidi N, Viseskul C, Gilbert E. Nonimmunologic hydrops fetalis. Am J Obstet Gynecol. Jul 1 1978;131(5):586-7. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

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

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Durre Sabih, MBBS, MSc, Visiting Faculty, Department of Nuclear Medicine, Pakistan Institute Applied Sciences and Nishtar Medical College; Director, Multan Institute of Nuclear Medicine and Radiotherapy
Disclosure: Nothing to disclose.

Coauthor(s)

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP, Chairman of Medical Imaging, Professor of Radiology, NGHA, King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, LRCP is a member of the following medical societies: American Institute of Ultrasound in Medicine, Radiological Society of North America, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Zahida Sabih, MBBS, MSc, 
Disclosure: Nothing to disclose.

Medical Editor

Christopher L Sistrom, MD, Associate Chair for Research, Assistant Professor, Department of Radiology, University of Florida School of Medicine
Christopher L Sistrom, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, Association of University Radiologists, Phi Beta Kappa, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Karen L Reuter, MD, FACR, Professor, Department of Radiology, Lahey Clinic Medical Center
Karen L Reuter, MD, FACR is a member of the following medical societies: American Association for Women Radiologists, American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.