Fetal Chest Normal And Pathology Flashcards
(120 cards)
1
Q
What is the diaphragm?
A
Hypoechoic linear structure between lungs and abdomen
2
Q
When is it easier to see the diaphragm?
A
Later gestations
3
Q
How is diaphragm usually visualized?
A
On Parasagittal scans
4
Q
What does the fetal lungs look like on U/S?
In terms of echotexture
A
Homogenous
5
Q
Fetal lungs are usually compared to what for echogenicity? What do we look for?
A
- Liver
- Isoechoic and hyperechoic
6
Q
What are requiremets of fetal lung needed for development? 3
A
- Adequate space for growth
- Fetal breathing movements
- Fluid within lungs to distend developing airways Adequate amniotic fluid volume
7
Q
How much of the fetal chest does the fetal heart take up?
A
1/3
8
Q
Where is the fetal heart located in relation of the fetal body?
A
Left of mediastinum and sits in the space in the chest between the lungs that contains the heart and other important structures
9
Q
How does the apex of the heart tilt/ point?
A
Apex points to the left with axis about 45 degrees
10
Q
What are some examples of lung pathology?9
A
- Pulmonary hypoplasia
- Congenital cystic adenmatoid malformation
- Congenital pulmonary airway malformation
- Pulmonary sequestration
- Bronchogenic cyst
- Diaphragmatic hernia
- Pleural effusion
- Esophageal atresia
- Tracheal atresia
11
Q
What is pulmonary hypoplasia?
A
When one or both lungs are underdeveloped
12
Q
In terms of pulmonary hypoplasia, fetus under which range are not considered viable due to pulmonary immaturity ? (weeks)
A
<24
13
Q
At term pulmonary hypoplasia is caused by what?4
A
- Restricted chest circumference/ rib cage (some restricted chest restriction)
- Chest masses
- Pleural effusion
- Decreased amniotic fluid (oligiohydramnios)
14
Q
Most frequent cause of pulmonary hypoplasia is what?2
A
Lack of amniotic fluid caused by
1. PROM - premature rupture of membranes
2. GU anomalies (genitourinary)
15
Q
Amniotic fluid is produced by membranes until when?
A
Fetal kidneys begin to produce urine
16
Q
What is the pathway of amniotic fluid for baby?5
A
- Fetus swallows amniotic fluid
- Fluid goes through GI tract
- Absorbed by the GI tract
- Exerted by kidneys as urine
- Fetus urinates back into the amniotic cavity
17
Q
Amniotic fluid is produced in a small amount by what?4
A
- Fetal lungs
- Fetal skin
- Nose
- Mouth
18
Q
Any high GI obstruction/ swallowing deficits causes what?
A
Polyhydraminos
19
Q
Any bilateral GU obstruction/ renal agenesis, causes what?
A
Oligiohydramnios
20
Q
What is the method to predict pulmonary hypoplasia sonograpically?2
A
- Transverse chest circumference at level of 4CH heart view
- Measure outer to outer (except in cases of skin edema/ hydrops)
21
Q
Congenital cystic adenomtoid malformation is now called what?
A
- CPAM
- Congenital pulmonary airway malformation
22
Q
What is the three classifications of CPAM?
A
- Type 1
- Type 2
- Type 3
23
Q
CPAM is a type of what disorder? Which lobe is affected?2
A
- Hamartoma
- Usually 1 lobe affected (95% unilateral)
24
Q
CPAM malformation communicates with what?
A
Tracheobronchial tree
25
Large CPAM can result in what?
Mediastinal shift
26
What happens with the mediastinal shift with a large CPAM?
Heart position deviates, compressing lungs and great vessels
27
CPAM is associated with what? 3
1. Hydrops
2. Pulmonary hypoplasia
3. Polyhydraminos
28
What does CPAM type 1 look like? 4 ( size, appearance, amount, contents)
1. Macrocystic
2. Single or multiple
3. Will appear as large, anechoic cystic spaces
4. >2cm
29
What does CPAM 2look like?3 (contents, size, echogenicity)
1. Macro and micro cystic
2. Mixed echogenicity
3. Cysts 0.5 - 2 cm
30
What is CPAM type 3?
1. Microsystems
2. Multiple microscopic cysts (0.5-5mm)
3. Appears as homogenous hyperechoic masses
31
What is the prognosis of CPAM?
Depends on mediastinal shift and whether hydrops occurs
32
Would CPAM have the chance to regress?
Yes it may even disappear on its own
33
Is any intervention needed for CPAM?
No intervention is performed unless hydrops is noted
34
What is the way we drain CPAM cysts?
Antenatally or surgically reset the mass postnatally
35
What is the DDX of CPAM? 3
1. Pulmonary sequestration
2. Bronchogenic cyst
3. CDH (Congenital diaphragmatic hernia)
36
What is pulmonary sequestration?
A mass of ectopic pulmonary tissue, covered by its own pleura
37
What is communication like for pulmonary sequestration?
There is no communication
38
In terms of pulmonary sequestration, what is the arterial supply like?
Ectopic arterial supply
39
What is the flow of blood in the venous system for pulmonary sequestration? Where is it generally based?
1. Venous to systemic system not pulmonary veins
2. 80% in left lung base
40
What is the sonographic appearance of pulmonary sequestration? What is it assocaited with? 2
1. Uniform hyperechoic mass
2. Associated with hydrops and polyhydraminos secondary to mass effect
41
When doing a sonographic investigation for pulmonary sequestration, what should we look for?
Feeding artery, off the aorta
42
What is the prognosis for pulmonary sequestration?
Good unless associated with hydrops, usually resolve on their own
43
What is a Bronchogenic cyst?
A cyst in the lung, lined with bronchial epithelium
44
Bronchogenic cyst results from what?
An abnormal budding of the foregut
45
What is Bronchogenic cysts associated with? 3
Forgot anomalies such as
1. TE fistulas
2. Esophageal duplications
3. Lung sequestration
46
What is the sonographic appearance of bronchitis cysts? 2
1. Uni/multiocular cysts
2. Mediastinal shift
47
What is a diaphragmatic hernia?
A defect in the diaphragm which allows abdominal contents to herniate up to the chest
48
What are some organs affected by diaphragmatic hernias? 3
1. Intestines
2. Stomachs
3. Liver
49
What are two types of diaphragmatic hernias?
1. Foramen of Bochdalek
2. Foramen of Morgagni
50
What is the DDX for pulmonary sequestration?
DDX
51
What is a foramen of bochdalek?
Posterior lateral defect, more common on left than right
52
What might we see with a left sided foramen of bochdalek? 2
1. May see stomach or intestine in chest
2. Lung with absence of diaphragm + Mediastinal shift
53
What does a right sided foramen of Bochdalek look like? (comparison to liver, mediastinal shift) 3
1. May see liver in chest
2. Difficult to recognize liver from lung
3. May not appreciate mediastinal shift as much
54
What kind of defect is a foramen of morgagni? What might we see with it? (diaphragm) 2
1. Retrosternal defect
2. Partial or complete absence of the central diaphragm
55
In terms of a foramen or morgagni, what do we normally see?
1. Liver herniated into chest
2. Mediastinal shift to extreme left (even though heart is still on left side the axis will be shifted)
56
What is the sonographic appearance of CDH? (congenital diaphragmatic hernia) 4 (main key sonographic sign is msot important)
1. **Mediastinal shift (Key sonographic sign)**
2. Cystic component in the fetal chest
3. Diaphragm not intact on sagittal scans
4. Stomach not seen in abdomen or stomach alignment is abnormal
57
How difficult are some cystic components in the fetal chest seen with CDH? When would we see them?
1. Difficult to catch
2. Only if fetus has recently been swallowing
58
What does CDH cause? (to the lungs)
Pulmonary hypoplasia
59
What is CDH associated with? 3
1. Increase in accompanying abnormalities
2. Chromosomal abnormalities including T18 and 21
3. Anencephaly most frequently then Hydrocephalus, encephaloceles, spina bifida
60
Majority of CDH defects original where?
CNS origin
61
What is eventration of diaphragm?
1. Diaphragm lacks muscle, therefore the abdominal contents push into chest area
62
Eventration of diaphragm may cause what? (to the lungs)
Pulmonary hypoplasia
63
What is another name for pleural effusion?
Hydrohorax
64
What is a pleural effusion?
Any amount of pleural fluid in abnormal at any gestation
65
If there is a large amount of pleural effusion, what might happen?
Pulmonary hypoplasia
66
What are two types of pleural effusions?
1. Primary
2. Secondary
67
What is seen with primary pleural effusions?
1. Chylous- lymphatic fluid
2. May be associated with polyhydraminos
68
What are things we see with secondary pleural effusions?
1. Serous filled
2. Signs of Hydrops
69
Secondary pleural effusions are usually associated with what disorder?
Downs and Turner’s syndrome
70
Pleural effusions are unilateral or bilateral?
Can be both
71
What is the sonographic appearance of pleural effusions? 3
1. Cystic collection above the diaphragm
2. In unilateral - may cause mediastinal shift
3. If large - may invert the diaphragm and cause pulmonary hypoplasia
72
What is the treatment of pleural effusions? 3
1. Thoracentesis
2. Shunt fluid into the abdomen or amniotic cavity
3. May resolve on its own
73
What are three examples of things that would shift the heart to the right?
Mass effects
1. Pleural effusion
2. Diaphragmatic hernia
3. CPAM
74
What is tracheal atresia?
Congenitally non patent airway
75
How common are tracheal atresia?
Rare, but is fatal post- nasally if not recognized
76
What is the sonographic appearance of tracheal atresia? 5
1. Bilaterally enlarged lungs with distended airways
2. May see fluid-filled trachea and main bronchi
3. Flat or inverted diaphragms
4. Heart shifted anteriorly
5. Ascites and polyhydramnios
77
In terms of tracheal atresia, a small amount of amniotic fluid is produced by what?
Fetal lung
78
With Tracheal atresia, fetal lungs will appear how?
Hyperechoic as this fluid cannot get out of the lungs. Because of increased fluid in the lung tissue the echogenicity is enhanced in the tissue
79
What is esophageal atresia?
Congenital absence of the continuation of the esophagus
80
Esophageal atresia is often associated with what?
TW
81
What is the sonographic appearance of esophageal atresia?
1. No stomach bubble
2. Cystic structure in neck (disappears)
82
What is esophageal atresia associated with? (disorders) 2
Down syndrome and VACTERL
83
What is the chest wall shape abnormalities? 3
1. Narrow
2. Long
3. Bell shaped (dwarfism, skeletal dysplasia)
84
Chest wall shape abnormalities may cause what? (to the lungs)
Pulmonary hypoplasia
85
What is ectopia cordis? What is seen with it? How obvious it it?
Chest wall abnormalities which has
1. Anterior chest all fusion defect
2. Heart is outside chest cavity
3. Obvious on real time scanning
86
What is pentalogy of Cantrell?
Syndrome involve 5 defects
87
What is the 5 defects of pentalogy of Cantrell?
1. Sternum
2. Anterior diaphragm
3. Pericardium
4. Ectopia cordis (likely with other heart defects)
5. Omphalocele
88
In terms of pentalogy of Cantrell, what two things are indicative of this anomaly?
Ectopia cordis and Omphalocele
89
What does this image represent?
Diaphragm
90
What does this image represent?
Fetal diaphragm
91
What does this image represent?
Fetal heart diaphragm and stomach
92
What does this image represent?
93
What does this image represent?
94
What does this image represent?
Chest with 4 chamber view
95
What does this image represent?
96
What does this image represent?
CPAM type 1
97
What does this image represent?
98
What does this image represent?
CPAM II
99
What does this image represent?
CPAM II
100
What does this image represent?
CPAM type II
101
What does this image represent?
CPAM III
102
What does this image represent?
CPAM CT
103
What does this image represent?
CPAM III
104
What does this image represent?
Pulmonary sequestration
105
What does this image represent?
Pulmonary sequestration
106
What does this image represent?
Bronchogenic cyst
107
What does this image represent?
Bronchogenic cyst
108
What does this image represent?
Bronchogenic cyst
109
What does this image represent?
Bronchogenic cysts
110
What does this image represent?
Foramen of Bochdalek
111
What does this image represent?
Congenital diaphragmatic hernia
112
What does this image represent?
Foramen of morgagni CDH
113
What does this image represent?
Pleural effusion/ edema
114
What does this image represent?
Pleural effusions and fetal edema
115
What does this image represent?
Pleural effusions
116
What does this image represent?
Tracheal Atresia
117
What does this image represent?
Tracheal atresia
118
What does this image represent?
119
What does this image represent?
Ectopia cordis
120
What does this image represent?
Ectopic cordis with amniotic band
