Decompression of fetal cardiac tamponade caused by congenital capillary hemangioma of the pericardium.

BACKGROUND: Isolated fetal pericardial effusion is rare but has been associated with various cardiac masses. Decompression in utero might prolong the pregnancy.

CASE: In a 34-year-old white woman, gravida 3, para 0-1-1-1, at 34 5/7 weeks' gestation, ultrasound detected massive fetal pericardial effusion that progressed rapidly to hydrops. The fetal heart was structurally normal. We decompressed the fetal cardiac tamponade by pericardiocentesis, removing 52 mL of straw-colored fluid, which improved fetal movement and hydrops. We did pericardiocentesis at 6 weeks postpartum for a large pericardial effusion. Two weeks later the effusion recurred and we did thoracotomy with pericardial window placement. Pathologic diagnosis of pericardial biopsy was congenital capillary hemangioma of the pericardium.

CONCLUSION: Isolated fetal pericardial effusion can be caused by capillary hemangioma of the pericardium despite lack of any mass on ultrasound. Decompression of pericardial effusion in utero might relieve fetal cardiac tamponade and extend pregnancy.