1Department of Obstetrics and Gynecology, Hiroshima City Hospital, 2Department of Obstetrics and Gynecology, Tokuyama Central Hospital, 3Department of Obstetrics and Gynecology, Yamaguchi University Hospital, 4Department of Pediatric Surgery, Hiroshima City Hospital
The prognosis of bronchopulmonary sequestration (BPS) complicated by hydrothorax, fetal hydrops, or pulmonary hypoplasia is generally considered poor. Prenatal thoracocentesis and thoracoamniotic shunting of massive hydrothorax are indicated to decrease perinatal morbidity. This report presents a case of BPS with a relatively good prognosis after thoracoamniotic shunting. A 34-year-old multigravida was referred to the hospital at 28 weeks and 6 days gestation for hydrothorax. Ultrasonography and MRI demonstrated a huge mass in the left thorax complicated by mediastinal shift to the right and large left pleural effusion. A combination including color Doppler ultrasound visualized a vessel arising from the descending aorta to the mass. These findings indicated extralobar BPS. Thoracocentesis was carried out during her first referral, when 32 mL of serous yellowish pleural effusion was removed. However, the pleural effusion reaccumulated on the following day and thoracoamniotic shunting was performed. A doublebasket catheter (16 G, Hakko Medical Products, Japan) was placed percutaneously under ultrasound guidance. The pleural effusion disappeared after shunting, and the bilateral lungs expanded. A female baby weighing 3110 g was successfully delivered with an Apgar score of 9(1’)/9(5’). The patient was transferred to the Neonatal Intensive Care Unit. The pleural effusion reaccumulated postnatally, and the patient required continuous drainage. Tumor resection was performed on the 7th postnatal day. A histopathologic examination revealed BPS. The patient was discharged on the 17th day and was doing well at 3 months of age. Thoracoamniotic shunting is considered to be an effective therapeutic option in cases of BPS complicated by hydrothorax.