Chylothorax Prenatal Diagnosis and Treatment: Case Study

Background. Congenital chylothorax results from abnormalities in lymphatic vessels development and increases perinatal death risk due to lymphatic fluid accumulation in pleural cavity with secondary pulmonary hypoplasia development. Thoraco-amniotic shunting (drain-age of fluid from the chest into the amniotic cavity in intrauterine baby) can increase children survival in such cases. Case presentation. Ultrasound examination has revealed left-side hydrothorax in the intrauterine child on the 22nd week of gestation. Thoracic-pulmonary index (ratio of total lung area to chest area, in percent) was 24.5% (normal values — 41.6 ± 2.5%). Thoracocentesis was performed at 28th week of gestation, 30 ml of straw-coloured liquid was gathered. High triglycerides level (4.77 mmol/L) was detected in the aspirate. Stent for thoraco-amniotic shunt was installed. Thoracic-pulmonary index after stenting was 40%. Second thoracocentesis was performed at 30+3 week of gestation due to non-functioning stent, 70 ml of straw-coloured liquid was aspirated. Pregnant woman had cramping pains in the lower abdomen at 35 weeks and 1 day of gestation. Thoracocentesis was performed before the Cesarean section, 30 ml of chylous fluid was aspirated. Live-born boy was delivered via Cesarean section, body weight — 2617 g, APGAR score — 5/6 points. The child was intubated immediately after birth, respiratory therapy (ALV) was initiated, as well as parenteral nutrition. The child’s thoracic cavity was drained on the left on the 1st day of life, and he was transferred to the neonatal surgery department on the 14th day. Conclusion. Prenatal diagnosis of congenital chylothorax is based on the detection of free fluid in thoracic cavity of intrauterine child starting from the 20th week of gestation. Thoracic-pulmonary index helps us to evaluate the degree of secondary pulmonary hypoplasia. Thoraco-amniotic shunting in utero improves treatment outcomes for congenital chylothorax by reducing lung hypoplasia degree in fetus.

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