reassure me, please

Today I had a sonogram, as part of a screening for birth defects -- I'm
at 11 weeks. Everything looked fine EXCEPT for, possibly, maybe, "some
fluid around the heart." Of course the doctor doing the sonogram
wouldn't tell me what that means -- it's something I have to ask my
regular doctor about, but I won't be seeing her for a few weeks. The
doctor did tell me that it's probably not anything significan -- the
heart sounded fine -- and that (when I asked), no, I shouldn't run
screaming out of the hospital. It's just something to keep an eye on,
because it can possibly "be a sign of... problems."

Anyone else run into fluid around the heart? We had a bad reading of the
20-week sonogram with our first kid, so I know to take it with a grain
of salt.
--
accompanied by TK, number two, due in April of 2006

I'm sorry I won't be able to be very reassuring without seeing the
images. This would be a very, very unusual finding in an 11 week fetus.
My initial response is to wonder about the skills of the person
interpreting the scan.

The technical term for fluid around the heart is pericardial effusion.
If this is a real finding, it can be associated with problems such as
hydrops and congenital heart defects (although there would be other
ultrasound findings to go along with these diagnoses, not just the
effusions). Again, it would be very unusual to be able to see such a
finding in an 11 week scan. Either this person is a genius with skills
and equipment far beyond my own, or else they're talking nonsense.

Was your ultrasound done at a specialized fetal diagnostic center? Or
was it done by the same radiology department that does all the x-rays
and CT scans and everything else for your hospital?

--------journal article abstract------------------------------
Journal of Ultrasound in Medicine, Vol 13, Issue 4 291-293, Copyright
=A9 1994 by American Institute of Ultrasound in Medicine

Clinical significance of isolated fetal pericardial effusion
D=2E N. Di Salvo, D. L. Brown, P. M. Doubilet, C. B. Benson and M. C.
Frates
Department of Radiology, Brigham and Women's Hospital, Boston,
Massachusetts 02115.

Prenatal sonographic identification of a small rim of pericardial
fluid, measuring less than 2 mm in thickness, is a normal finding.
Pericardial fluid 2 mm or greater in thickness may be associated with
structural anomalies or hydrops, but its clinical significance in the
absence of these associated findings has not been evaluated. We
assessed the outcome in fetuses with isolated pericardial effusions of
at least 2 mm thick. Our study population included 52 fetuses with
effusions ranging from 2 to 7 mm in thickness. We compared rates of
preterm delivery, cesarean section, intrauterine growth retardation,
perinatal complications, Apgar scores, and length of neonatal hospital
stay in these 52 cases to the overall hospital rates and found no
statistically significant difference. We conclude that in the absence
of other sonographic abnormalities, the finding of a fetal pericardial
fluid collection 2 to 7 mm in thickness is not associated with adverse
outcome.

I'm sorry I won't be able to be very reassuring without seeing the
images. This would be a very, very unusual finding in an 11 week fetus.
My initial response is to wonder about the skills of the person
interpreting the scan.

The technical term for fluid around the heart is pericardial effusion.
If this is a real finding, it can be associated with problems such as
hydrops and congenital heart defects. Again, it would be very unusual
to be able to see such a finding in an 11 week scan. Either this person
is a genius with skills and equipment far beyond my own, or else
they're talking nonsense.

Was your ultrasound done at a specialized fetal diagnostic center? Or
was it done by the same radiology department that does all the x-rays
and CT scans and everything else for your hospital?

--------journal article abstract------------------------------
Journal of Ultrasound in Medicine, Vol 13, Issue 4 291-293, Copyright
=A9 1994 by American Institute of Ultrasound in Medicine

Clinical significance of isolated fetal pericardial effusion
D=2E N. Di Salvo, D. L. Brown, P. M. Doubilet, C. B. Benson and M. C.
Frates
Department of Radiology, Brigham and Women's Hospital, Boston,
Massachusetts 02115.

Prenatal sonographic identification of a small rim of pericardial
fluid, measuring less than 2 mm in thickness, is a normal finding.
Pericardial fluid 2 mm or greater in thickness may be associated with
structural anomalies or hydrops, but its clinical significance in the
absence of these associated findings has not been evaluated. We
assessed the outcome in fetuses with isolated pericardial effusions of
at least 2 mm thick. Our study population included 52 fetuses with
effusions ranging from 2 to 7 mm in thickness. We compared rates of
preterm delivery, cesarean section, intrauterine growth retardation,
perinatal complications, Apgar scores, and length of neonatal hospital
stay in these 52 cases to the overall hospital rates and found no
statistically significant difference. We conclude that in the absence
of other sonographic abnormalities, the finding of a fetal pericardial
fluid collection 2 to 7 mm in thickness is not associated with adverse
outcome.

alath wrote:
(snip)

Was your ultrasound done at a specialized fetal diagnostic center? Or
was it done by the same radiology department that does all the x-rays
and CT scans and everything else for your hospital?

Just interjecting here because I think I understand what alath is
getting at with the above question. The specialists have wicked cool
equipment for looking at fetal hearts. I say this from personal
experience: the images from a regular ultrasound can't compare to those
done by a neonatologist. When I was about 7 months along with DS2 my OB
discovered a an irregular heartbeat during a routine visit. About an
hour later I was in the waiting room of the neonatologist's office
waiting to have a fetal echocardiograph. We actually got to see the
blood enter and exit each of the chambers of DS2's heart (in color).
IIRC it even had a way to measure the amount of oxygen in his blood(but
that could be just some weird recollection...but there were many
gradations in color on the images that were measuring something).
Luckily there wasn't anything structurally wrong with DS2's heart, but
it was hard to say at that point whether his heart would continue to
miss beats (and need a pacemaker)...so I had a follow up 2 weeks later
to re-check it. By then his heart apparently had matured and was
beating normally.

If the doc is truly concerned, then in all liklihood a visit to a
neonatologist will be recommended.

annette

alath wrote:

I'm sorry I won't be able to be very reassuring without seeing the
images. This would be a very, very unusual finding in an 11 week fetus.
My initial response is to wonder about the skills of the person
interpreting the scan.

The technical term for fluid around the heart is pericardial effusion.
If this is a real finding, it can be associated with problems such as
hydrops and congenital heart defects (although there would be other
ultrasound findings to go along with these diagnoses, not just the
effusions). Again, it would be very unusual to be able to see such a
finding in an 11 week scan. Either this person is a genius with skills
and equipment far beyond my own, or else they're talking nonsense.

Was your ultrasound done at a specialized fetal diagnostic center? Or
was it done by the same radiology department that does all the x-rays
and CT scans and everything else for your hospital?


In the radiology department of a hospital. They weren't 100% sure that
that was what they were seeing, and everything else was fine -- they
actually were a bit puzzled by it. I think I'll go with the "talking
nonsense" idea until my next sonogram, or if my own doctor wants me to
see a fetal specialist.


--------journal article abstract------------------------------
Journal of Ultrasound in Medicine, Vol 13, Issue 4 291-293, Copyright
© 1994 by American Institute of Ultrasound in Medicine

Clinical significance of isolated fetal pericardial effusion
D. N. Di Salvo, D. L. Brown, P. M. Doubilet, C. B. Benson and M. C.
Frates
Department of Radiology, Brigham and Women's Hospital, Boston,
Massachusetts 02115.

[snip]

Interesting -- and encouraging -- thanks!
--
accompanied by TK, number two, due in April of 2006

In article . com,
wrote:

alath wrote:
(snip)

Was your ultrasound done at a specialized fetal diagnostic center? Or
was it done by the same radiology department that does all the x-rays
and CT scans and everything else for your hospital?

Just interjecting here because I think I understand what alath is
getting at with the above question. The specialists have wicked cool
equipment for looking at fetal hearts. I say this from personal
experience: the images from a regular ultrasound can't compare to those
done by a neonatologist. When I was about 7 months along with DS2 my OB
discovered a an irregular heartbeat during a routine visit. About an
hour later I was in the waiting room of the neonatologist's office
waiting to have a fetal echocardiograph. We actually got to see the
blood enter and exit each of the chambers of DS2's heart (in color).
IIRC it even had a way to measure the amount of oxygen in his blood(but
that could be just some weird recollection...but there were many
gradations in color on the images that were measuring something).
Luckily there wasn't anything structurally wrong with DS2's heart, but
it was hard to say at that point whether his heart would continue to
miss beats (and need a pacemaker)...so I had a follow up 2 weeks later
to re-check it. By then his heart apparently had matured and was
beating normally.

If the doc is truly concerned, then in all liklihood a visit to a
neonatologist will be recommended.

Interesting -- thanks. The equipment the doctor used today definitely
wasn't that high res. Today's doctor didn't say anything about a
specialist, just that it was something they'd look for at the next
sonogram.
--
accompanied by TK, number two, due in April of 2006

The specialists have wicked cool
equipment for looking at fetal hearts.

Good equipment does help, but what matters most is the expertise of the
person generating the images and the expertise of the person
interpreting the images. Fetal diagnosticians were making good fetal
diagnoses 10 and 20 years ago, long before all the whiz-bang technology
came along.

If the doc is truly concerned, then in all liklihood a visit to a
neonatologist will be recommended.

Perinatologist (aka maternal-fetal medicine subspecialist).

Neonatologists are for after the baby is born ;-)