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OB Pathology > Chpt. 60 Fetal Thorax > Flashcards

Chpt. 60 Fetal Thorax Flashcards

1
Q

What is the single most important determinant for fetal viability?

A

Adequacy of pulmonary development

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2
Q

What is the major reason why fetuses younger than 24 weeks of gestation are generally considered nonviable?

A

Pulmonary immaturity

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3
Q

Breathing movements that occur before birth results in ?

A

The aspiration of fluid into the lungs

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4
Q

Name the three routes that fluid in the lungs (at birth) are cleared by?

A

1) through the mouth and nose
2) into the pulmonary copillaries
3) into the lymphatic’s and pulmonary vessels

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5
Q

The fetal thorax is examined in what planes?

A

transverse and coronal or parasagittal plane

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6
Q

what is the normal shape of the thoracic cavity?

A

symmetrically bell shaped, with the ribs forming the lateral margins, the clavicles forming the upper margins, and the diaphragm forming the lower margin

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7
Q

The lungs serve as lateral border for ? and lie superior to ?

A

heart and diaphragm

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8
Q

How much fluid is in the lungs at birth?

A

They are half full

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9
Q

describe the diaphragm sonographically

A

echogenic smooth hypoechoic muscular margin between the fetal liver or spleen and the lungs

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10
Q

Which is normally slightly smaller? thorax or abdominal cavity

A

thorax

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11
Q

where are the chest circumference measurements made from?

A

transverse plane at the level of the four chamber view of the heart

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12
Q

A fetus with a significant narrow diameter of the chest may have?

A

asphyxiating thoracic dystrophy

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13
Q

What syndrom is associated with asphyxiating thoracic dystrophy?

A

Thanatophoric dwarfism

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14
Q

The central portion of the thorax is occupied by the _________.

A

mediastinum

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15
Q

Majority of the heart is positioned in the ?

A

midline and left chest

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16
Q

How should the apex of the heart be directed?

A

toward the left chest wall at an axis that is 45 degrees from midline

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17
Q

The heart occupies _______ of the chest?

A

1/3

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18
Q

What direction does the base of the heart lie to the diaphragm?

A

Horizontal

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19
Q

why is the location of the heart important to document?

A

as detection of abnormal heart position may indicate the presence of a chest mass, pleural effusion, or cardiac malformation

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20
Q

How do the fetal lungs appear sonographically?

A

homogenous with moderate echogenicity

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21
Q

In early gestation, the lungs are similar to or slightly _____ echogenic than the liver?

A

less

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22
Q

As gestation progresses, there is a trend toward increased pulmonary echogencicty relative to ?

A

liver

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23
Q

When is fetal breathing movements considered absent?

A

if no such fetal activity is noted during a 20 minute observation period

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24
Q
A
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25
Q

what is used to detect fetal breathing through the nostrils?

A

Color flow doppler

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26
Q

when does fetal breathing become more prominent?

A

2nd and 3rd trimesters

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27
Q

The mature fetus spends how much time breathing?

A

almost 1/3

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28
Q

when are fetal breathing movements documented?

A

when seesaw movements of the fetal chest or abdomen are sustained for 20 seconds

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29
Q

What should you evaluate when looking at a fetus for a lung mass?

A

1) postion of the heart
2) orientation of the cardiac axis
3) Measurement of the thoracic circumference

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30
Q

What should you look for when the heart position and axis vary from the normal position?

A

any abnormality that may be the cause of such displacement

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31
Q

What is fetal echo beneficial for excluding?

A

cardiac involvement, and evaluation of an intact diaphragm is necessary to exclude diaphragmatic hernia

32
Q

The lungs will not grow or develop properly when?

A

1) small uterine cavity resulting from severe oligohydraminos
2) chest cavity os abnormally small
3) When the balance between tracheal and airway pressure and fluid volume is inadequate
4) fetus is unable to practice breathing movement

33
Q

Pulmonary Hypoplasia is caused by?

A

a decrease in the number of lung cells, airways and alveoli, with a resulting decrease in organ size and weight

34
Q

Pulmonary hypoplaia results in?

A

small inadequate development of lungs

35
Q

pulmonary hypoplasia most commonly occurs from _________ _________ or is secondary to a small thoracic cabity as a result of a structural or ________ _________.

A

prolonged oligohydraminos; chromosomal abnormality

36
Q

Pulmonary hypoplasia may also occur in fetuses with?

A

severe intrauterine grown restriction and early rupture of the membranes

37
Q

Pulmonary hypoplasia may be caused by ?

A

masses within the thoracic cavity

38
Q

Name the masses withing the thoracic cavity? (5)

A

1) pleural effusion
2) diaphragmatic hernia
3) cystic adenomatoid malformatin of the lung
4) bronchopulmonary sequestation
5) other lg. cyst and tumors of the lungs and thorax, may lead to pulmonary hypoplasia

39
Q

what may manifest with pulmonary hypoplasia?

A

cardiac defect, skeletal dysplasias, central nervous system disorder, and chromosomal trisomies ( 13, 18 and 21)

40
Q

Sonographic finding of pulmonary hypoplasia

A

1) Thoracic measurements
2) various lung measurements
3) estimation fo lung volume
4) doppler studies of the pulmonary arteries
5) assessment of fetal breathing activity

41
Q

Accumulation of fluid within the pleural cavity that may appear as an isolated lesion or secondary to multiple fetal anomalies is called?

A

pleural effusion or hydrothorax

42
Q

what is the sonographic appearance of pleural effusion?

A

echo free peripheral masses on one or both sides of the fetal heart

43
Q

________ are ehco free masses that replace normal lung parenchyma

A

Lung Cyst

44
Q

Lung cystic masses may cause notable shifts of the ?

A

intrathoracic structures

45
Q

what is the most common lung cyst detected prenatally?

A

Bronchogenic cyst

46
Q

where does bronchogenic cyst usually occur?

A

within the mediastinum or lung; infrequently they are inferior to the diaphragm

47
Q

Sonographically the bronchogenic cyst appear?

A

as small circumscribed masses without evidence of a mediastinal shift or heart failure

amniotic fluid volume is within a norma range

48
Q

Pleural effusions conform to the _______ cavity and often compress ________ tissue.

A

thoracic, lung

49
Q

T/F; The lung appears to float in fluid

A

True

50
Q

Pleural fluid is rarely encountered before the _____ week of gestation, except in association with _______ or_______ syndrom

A

15th, down or turner’s

51
Q

compression of lung parenchyma may cause?

A

pulmonary hypoplasia (repersent life threating consequence for neonate)

52
Q

The presence of a pleural effusion may cause a shift of ?

A

mediatinal structures, compression fo the heart, and inversion fo the diaphragm

53
Q

In the presence of _____ the shpe of the lung appears normal

A

pleural effusion

54
Q

Once a pleural effusion has been discovered a careful search for ______ (3)should be attempted?

A

cardiac, lung, and diaphragmatic lesions

55
Q

when pleural effusion is large, lung develoopment is impaired, which may result in?

A

pulmonary hypoplasia

56
Q

with pleural effusion signs of ________ should be performed?

A

hydrops (ascites, scalp edema, and tissue edema)

57
Q

solid tumors of the fetal lungs appear as?

A

echo dense masses in the lung tissue

58
Q

Name two solid lung masses?

A

pulmonary sequestration and certain types of cystic ademomatoid malformations

59
Q

__________ is a supernumerary lobe of the lung, separated from the normal tracheobronchial tree

A

pulmonary sequestration

60
Q

In pulmonary sequestration, extra pulmonary tissue is present within the ______ ______ ___ or is connected to the inferior border of the _______ within its own pleural sac.

A

pleural lung sac; lung

61
Q

In solid lung masses the lung tissue is nonfuntional and recieves its blood supply for what?

A

systemic circulation

62
Q

In solid lung masses the arterial supply is usually from?

A

thoracic aorta, with venous drainage into the vena cava

63
Q

Sonographically solid lung mass appear?

A

echo-dense solid mass resembling lung tissue is observed, usually in the lower lobe of the lung

64
Q

Majority of extralobar defects occur on the ?

A

left side, rarely below the diaphragm

65
Q

describe intralobar lesions?

A

spherical, and extralobar sequestration appears as a cone shaped or triangular mass

66
Q

______ is one of the bronchopulmonary foregut malformations?

A

CCAM

67
Q

is a multicystic mass within the lung consisting of primitive lung tissue and abnormal bronchial and bronchiolar-like structures?

A

Congenital cystic adenomatioid malformation

68
Q

How may forms of cystic adenomatoid malformation are there?

A

3

1) CCAM type I
2) TypeII
3) type III

69
Q
A
70
Q

one or more large systs replace normal lung tissue ) single or multiple cysts measuring more than 2 cm and up to 19 cm)

A

CCAM type I

71
Q

Type II of cystic adenomatoid malformation constist of ?

A

multiple small cysts (less than 1 cm)

72
Q

In cystic adenomatoid malformation type II lesions are assoicated with?

A

fetal and/or chromosomal abnormalities in 25% of cases

73
Q

In type II lesions of cystic adenomatoid malformation name the three chromosomal abnormalities?

A

1) renal agenesis
2) pulmonary anomalies
2) diaphragmatic hernia

74
Q

Type III malformation fo cystic adenomatoid are characterized as?

A

bulky, large, noncystic lesions appearing as echo-dense masses of the entire lung lobe

75
Q
A

OB Pathology (16 decks)

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