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Business Process Mgmt > Fetal Chest > Flashcards

Fetal Chest Flashcards

1
Q

What are the stages of lung development?

A 
embryonic
pseudeoglandular
canalicular
saccular
alveolar
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2
Q

Air-blood barrier is formed when?

A

16-24 wks

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3
Q

The heart occupies how much of the fetal chest

A

1/3 (25-30%)

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4
Q

What angle do we want to see the heart at

A

45

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5
Q

What can be the first clue of unilateral chest mass or diaphragmatic hernia?

A

cardiomediastinal shift

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6
Q

The lungs are what to the liver? (echogenicity)

A

echogenic

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7
Q

Echogenicity of the lung ________ as gestation advances

A

increases

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8
Q

Pulmonary hypoplasia:

A

reduction in the number of cells, airways and alveoli

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9
Q

Is pulmonary hypoplasia unilateral or bilateral?

A

can be both depending on the etiology and time of effect to the lungs

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10
Q

Primary pulmonary hypoplasia:

A

caused by a primary process that does not let the lungs form normally
uni- a/w other abnormalities
bilateral- incompatible with life

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11
Q

Secondary pulmonary hypoplasia:

A

masses, skeletal malformations, oligohydramnios can cause this

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12
Q

Majority of pulmonary hypoplasia cases are associated with:

A

major structural or chromosomal abnormalities

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13
Q

Congenital diaphragmatic hernia:

A

abdominal viscera in the thoracic cavity due to a defect in diaphragm
can be tiny opening to complete absence of hemidiaphragm
can be surgically repaired

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14
Q

Which side more common for congenital diaphragmatic hernia

A

Left

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15
Q

Left sided CDH:

A

small abdo circumference, stomach or bowel in left chest, and polyhydramnios

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16
Q

What’s associated with left sided CDH?

A

dextroposition of the heart

stomach may not be visualized in LUQ and bowel peristalsis can be seen

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17
Q

Right sided CDH:

A

liver herniates into chest and mediastinal is to the left
liver’s echogenicity is similar to lungs
can potentially see GB and hep vessels which can help confirm diagnosis

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18
Q

What can we see with right sided CDH:

A

bowel herniation, but stomach is below diaphragm
ascites and hydrops
absence of hypoechoic aspect of diaphragm on the right helps differentiate

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19
Q

What helps in differentiating CDH from other fetal chest masses?

A

absence of the hypoechoic aspect of the diaphragm on the right

20
Q

What is associated with CDH?

A

structural chromosomal or syndromal anomalies
CHD (most common)
anecephaly, ventriculomegaly and neural tube
Tri18
Fryn, Beckwidth-Wiedemann,Simpson-Golabi-Behmel, Brachmann-de lange and Perlman syndromes

21
Q

Is the prognosis good for CDH?

A

No. 80% mortality rate due to pulmonary hypoplasia or CHF

22
Q

The most common defects occur on the _____ _____ ________ and involve the herniation of the stomach and small bowel in the chest. (90%)

A

left side posteriorly

23
Q

Pleural effusion is also known as

A

hydrothorax

24
Q

Pleural effusion is most often a manifestation of:

A

fetal hydrops, ascites and edema

25
Q

How can pleural effusion be managed?

A

Depending on GA and detected fetal anomalies, a US thoraco-amniotic shunt can be put in

26
Q

What is a thoraco-amniotic shunt?

A

a drainage tube with one end in the pleural space and the other in amniotic fluid

27
Q

Congenital Cystic Adenomoid Malformation (CCAM):

A

rare
lung tissue is replaced by cysts of varying sizes
abnormal growth of lung tissue can compress normal lung tissue and affect development

28
Q

CCAM is described as _______ _______ of the lungs.

A

focal dysplasia

29
Q

What’s the most common congenital lung lesion?

A

CCAM

30
Q

What are the 3 pathological types of CCAM?

A

Type 1: mainly cystic, single or multiple cysts (2-10cm in diameter)
Type 2: mainly solid w/ multiple small cysts <2cm
Type 3: mainly solid lesion with tiny cysts <0.5cm (hyperechoic without detectable cysts)

31
Q

What causes CCAM?

A

pulmonary insult during embryonic development of the bronchial tree before 7th wk of gestation

32
Q

What is the outcome of the cysts in CCAM?

A

may dimish in size and regress before/after birth

may require intervention/respiratory support

33
Q

What are the pathological features of CCAM?

A

unilater
one part of lung (lower lobe most common)
complications- PH, heart compression, fetal hydrops and polyhydramnios

34
Q

Bronchopulmonary sequestration:

A

presence of non-functioning pulmonary tissue (doesn’t have communication with bronchial tree)

35
Q

Where does the non-functioning tissue in bronchopulmonary sequestion get its blood supply?

A

anomalous artery from aorta rather than pulmonary artery branch

36
Q

What are the 2 major types of bronchopulmonary sequestration?

A

Intralobar

Extralobar

37
Q

Intralobar sequestration:

A

abnormal tissue lies within normal lung, usually in posterior segment of lower lobe

38
Q

Extralobar sequestration:

A

abnormal tissue is anatomically separated from the normal lung
most common location is left chest in basal region (near diaphragm)

39
Q

Extralobar pulmonary sequestration appears as:

A

a homogenous echogenic chest mass with or without cardiac shift

40
Q

Differential diagnosis of bronchopulmonary sequestration? (2)

A

Type 3 CCAM
CDH

(If the abdominal viscera appear normal (stomach, liver, and bowel identified in their normal locations), then CDH can be excluded)

41
Q

Bronchogenic cysts:

A

rare

result from abnormal budding of the tracheobronchial tree (size is variable)

42
Q

What’s the difference between a bronchogenic cyst and a CCAM?

A

CCAM has more than one cyst and an echogenic mass

43
Q

Tracheoesophageal fistula:

A

abnormal connection b/w esophagus and trachea

common congenital abnormality

44
Q

What causes a tracheoesophageal fistula?

A

failed fusion of the tracheoesophageal ridges during the 3rd week of embryological development

45
Q

Can you see a tracheoesophageal fistula easily on US?

A

No

Business Process Mgmt (30 decks)

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