Fetal Chest

Question 1

Ossification of clavicles occur during what week?

Scapula?

Sternum?

Answer 1

Clavicles: 8 weeks

Scapula: 10 weeks

Sternum: 21-27 weeks

Question 2

When may the soft tissues in the chest appear thickened?

Answer 2

1. Fetal edema
2. Fat deposits due to a diabetic mother

Question 3

What can thoracic circumference help rule out?

Answer 3

Pulmonary hypoplasia

Question 4

At what level in a TRV view is a thoracic circumference measured?

Answer 4

Level of the heart just above the diaphragm

Question 5

T or F? All TC/AC ratios that are low are due to pulmonary hypoplasia

Answer 5

FALSE: A small TC could just be a small thorax and be completely normal

Question 6

How much of the thorax should the heart take up?

Answer 6

1/3 - at the level of the AV valves

Question 7

In what possible situations may the heart take up more than 1/3rd of the thorax?

Answer 7

1. Pulmonary Hypoplasia
2. Cardiomegaly

Question 8

What do the primary bronchial buds grow into?

Answer 8

The pleural cavity

Question 9

In what week does the bronchi form?

Answer 9

5th

Question 10

When does respiration become possible?

Answer 10

24th week

Question 11

What structure aids in respiration?

Answer 11

Terminal saccules

Question 12

What is the lung echogenicity early in gestation compared to later?

Answer 12

Equal or less than the liver earlier and becomes brighter with increasing gestation

Question 13

T or F? Sonography is a good tool to assess lung maturity

Answer 13

FALSE

Question 14

Is the thymus located anterior or posterior to the Ao and PA?

Answer 14

Anterior

Question 15

When is assessing the thymus useful?

Answer 15

When predicting IUGR and chorioamnionitis

Question 16

At what vertebral level is the larynx located?

Answer 16

C3-6

Question 17

What may be suspected in the presence of a persistently fluid filled trachea?

Answer 17

Laryngeal atresia or stenosis

Question 18

T or F? Bronchogenic cysts communicate directly with trachea or main stem bronchi

Answer 18

TRUE

Question 19

What may fetuses present with in cases of CCAM?

Answer 19

Hydrops
Ascites
Polyhydramnios

Question 20

Sonographic features of the types of CCAM?

Answer 20

Type I - pulmonary mass with one or more large cysts (2-10cm)

Type II - echogenic mass with small cysts (0.5 - 2cm)

Type III - Homogenous echogenic mass

Question 21

How can you tell a CCAM apart from pulmonary sequestration or diaphragmatic hernia?

Answer 21

Colour - CCAM presents vascularity

Question 22

T or F? Pulmonary sequestration communicates with the tracheobronchial tree

Answer 22

FALSE: It is a piece of non-functioning lung tissue

Question 23

T or F? Pulmonary sequestration is more common in females

Answer 23

FALSE

Question 24

Do patients with intralobar or extralobar pulmonary sequestration have a better prognosis?

Answer 24

Extralobar

Question 25

In CCAM, where does its blood supply come from?

Answer 25

Pulmonary artery

Question 26

What is immune fetal hydrops also called?

Answer 26

Erythroblastosis fetalis

Question 27

What may cause immune fetal hydrops?

Answer 27

1. Rh incompatibility 2. Anemia

Question 28

What form of hydrops is most lethal?

Answer 28

Non-immune

Question 29

What may cause non-immune hydrops?

Answer 29

1. TORCH infections 2. Heart arrythmias 3. Chromosomal abnormalities: Turner syndrome, Trisomies 18 and 21

Question 30

Sonographic findings of non-immune hydrops?

Answer 30

1. Skin thickening 2. Pleural and pericardial effusion 3. Ascites 4. Hepatomegaly 5. Splenomegaly

Question 31

What does CDH stand for?

Answer 31

Congenital Diaphragmatic Hernia

Question 32

What is the postero-lateral CDH called?

Answer 32

Foramen of bochdalek and is the most common

Question 33

On what side are CDH usually occur?

Answer 33

Left

Question 34

What is the term for bowel protruding from the abdomen into the diaphragm?

Answer 34

Eventration

Question 35

What is antero-medial herniation called?

Answer 35

Foramen of margagni

Question 36

Why are left sided hernias more common?

Answer 36

Because the liver protects the right side and prevents herniation

Question 37

What can result in a good prognosis of CDH?

Answer 37

If surgical intervention is done before lung development completes (24 weeks)

Question 38

In what week does the bronchi form?

Answer 38

5th week

Question 39

What comprises half of all intra-thoracic abnormalities noted on fetal examinations?

Answer 39

Pleural Effusion

Question 40

In what trimester does CCAM begin to develop? When will it be seen on ultrasound?

Answer 40

First but won't be seen on ultrasound until the second

Question 41

T or F? Serial examinations have demonstrated a significant decrease or the spontaneous resolution of CCAMs antenatally

Answer 41

True

Question 42

Why is it important to evaluate the post skin surface?

Answer 42

Look for breaks in the skin --> myelomeningocele