Pleural Effusions

[Millypo]

Hi,

I am 34 weeks pregnant and just had a echocardiogram to look at my heart and pulmonary pressures.  I have a history of exercise-induced PH, along with undifferentiated autoimmune disease.  All looked good except the echo indicated a moderate size left pleural effusion.  A follow-up x-ray didn't show any effusions.  A nurse told me that perhaps the echo tech and doctor who read the echo mistook my uterus for my lungs.  A doctor told me that this is not likely as pleural effusions are easily identifiable on echo and that probably I have a small loculated pleural effusion that showed up in the echo, during which I was lying on my left side, but not on the upright, standing x-ray.  I am just wondering if it is common to have loculated pleural effusions that show on echo but not on x-ray.  If so, are loculated pleural effusions more common in pregnancy or is this something that is more likely related to my heart or autoimmune conditions?

Thanks!

[National Jewish Health]

No one mistakes the uterus for lungs.  Small pleural effusions during a normal pregnancy are common.  Given that this would be a benign effusion, the likelihood of loculation would be small.  A loculated effusion would change little, if at all with a change in position.  It is conceivable that the ECHO would be a more sensitive detector of a small amount of fluid.  Also in the absence of other signs of activation of your autoimmune disease and the "negative" chest x-ray, it would be prudent to do no further diagnostic procedures at this time.

[Millypo]

Thanks so much for your reply.  I am glad to know that it is unlikely the echo tech and doctor mistook my uterus or other organs for the bottom of my lungs.  It is so important that the people conducting and reading these tests know how to perform and read them properly, especially in pregnant patients where results require follow up with tests that involve risks to the baby.  When I had to have the x-ray due to the abnormal echo results, the x-ray tech at the hospital and their consent form warned of all kinds of potential harm to the baby as a result of the x-ray and it was a very stressful decision to make as to whether to go forward with the x-rays.  So, for many reasons, these echos and other tests need to be reliable and performed and read carefully.  Also, thank you for the information on the loculated pleural effusion.  It makes sense that this form of effusion wouldn't change much based on position.  As for autoimmune, I'm having a few signs of autoimmune flare, but not much.  I feel that the pregnancy has helped my autoimmune condition, in fact.  So we'll see.  I am having episodes of water retention and discomfort in my chest and in breathing on certain days, but this is not unusual for pregnancy I hear.  So all is going pretty well for now given my health conditions, and the baby looks good.

Thanks again for your input!

[Millypo]

Also, forgot to mention that the assumption is that the since the x-ray didn't show an effusion, the finding is not significant and was most likely an error in the reading due to the pregnancy.  So no further follow-up will be needed as the finding really doesn't mean anything significant.  Is this correct?

Thanks again!