Ultrasound Differential Between Fetal Hydrops and Cystic Hygroma

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Fetal hydrops is a condition in fetus that shows fluid accumulation (edema) in two or more fetal compartments, fluid accumulation can be seen in:

  • Abdominal cavity (ascites)
  • Pericardium (pericardial effusion)
  • Pleural cavity (pleural effusion)
  • Generalize edema

Picture shows aborted edematous fetus

Fetal hydrops is not a disease but an ultrasound indicator for other intra-uterine complications. Fetal hydrops can be immune or non-immune related in fetal anemia, however non-immune hydrops can be independent of anemia in which case tumor or congenital cystic adenomatoid malformation cause increase blood flow demand. This over-bearing cardiac output leads to edema secondary to fetal heart failure.
Immune fetal hydrops is seen in unmanaged Rh disease. This incident has since reduced with an improved Rh disease management.
Non-immune fetal hydrops has multiple causes, click here to learn more.

Fetal cystic hygroma is a congenital malformation of the lymphatic system appearing as an infiltrative cystic mass with single or multiloculated fluid filled cavities and variable density of fluid, soft tissue and fat combination. They are caused by lymphatic system blockage and usually around the neck. This usually results to hydrops. Cystic hygroma can be caused by both genetic and environment factors such as:
  • Viral infection
  •  Drug or alcohol use during pregnancy
  •  Some chromosomal abnormality
Pictures shows IU and after birth of cystic hygroma
Things to have in mind for differential considerations during antenatal ultrasound includes:
  • Cervical teratoma
  • Occipital encephalocele
  • Cervical meningocele

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