Fetal Chest Pathology/GI

Question 1

How much of the chest cavity does the heart take up and which way should the apex point?

Answer 1

1/3, points to the left

Question 2

When one or both lungs are underdeveloped

Answer 2

Pulmonary hypoplasia

Question 3

Why are fetuses <24 weeks not considered viable?

Answer 3

Pulmonary immaturity

Question 4

Most common cause of pulmonary hypoplasia

Answer 4

Lack of amniotic fluid

Question 5

High GI obstruction/swallowing deficits causes?

Answer 5

Polyhydramnios

Question 6

Any bilateral GU obstruction/renal agenesis causes what?

Answer 6

Oligohydramnios

Question 7

At what level is a chest circumference measured? What is proper caliper placement?

Answer 7

4 chamber heart in transverse, measured outer to outer

Question 8

What is CPAM

Answer 8

Congenital pulmonary airway malformation

Question 9

Briefly describe CPAM type 1

Answer 9

Macrocystic >2cm

Question 10

Describe CPAM type 2

Answer 10

Macro & microcystic, <1.5cm

Question 11

Describe CPAM type 3

Answer 11

Microcystic, appears as very echogenic on U/S

Question 12

Ectopic pulmonary tissue covered by its own pleura (little lung beside the left lung)

Answer 12

Pulmonary sequestration

Question 13

Has an ectopic arterial supply off descending AO

Answer 13

Pulmonary sequestration

Question 14

A cyst in the lung lined with bronchial epithelium

Answer 14

Bronchogenic cyst

Question 15

A defect in the diaphragm which allows the abdominal contents to herniate into the chest

Answer 15

Diaphragmatic hernia

Question 16

Two types of diaphragmatic hernias

Answer 16

1. Foramen bochdalek: posterior lateral defect

2. Foramen maorgagni: central defect

Question 17

What is the key sonographic sign of CDH? (Diaphragm hernia)

Answer 17

mediastinal shift

Question 18

Lack of muscle in the diaphragm where abdominal contents push into chest area

Answer 18

Eventration of the diaphragm

Question 19

Any amount of pleural fluid is abnormal at any gestation

Answer 19

Pleural effusions, may cause pulmonary hypoplasia

Question 20

2 types of pleural effusion

Answer 20

1. Serous

2. Chylous- lymphatic fluid

Question 21

Congenitally non patent airway

Answer 21

Tracheal atresia

Question 22

Congenitally non patent esophagus

Answer 22

Esophageal atresia

Question 23

Anterior chest wall fusion defect that may cause the heart to be outside the cavity

Answer 23

Ectopia cordis

Question 24

5 defects involved: sternum, anterior diaphragm, pericardium, ectopia cordis, omphalocele

Answer 24

Pentalogy of Cantrell

Question 25

Bronchopulmonary sequestration is difficult to differentiate from which CPAM?

Answer 25

CPAM 3

Question 26

Which congenital lung lesion is a hamartoma?

Answer 26

CPAM

Question 27

A mediastinal shift with dextrocardia is detected on a fetus. What other finding would support congenital diaphragmatic hernia?

Answer 27

Absent fetal stomach

Question 28

With tracheal atresia, the lungs will appear?

Answer 28

Enlarged with distended airways

Question 29

An absent stomach on a fetal AC is concerning for what?

Answer 29

Diaphragmatic hernia and esophageal atresia

Question 30

At 8 weeks, the gut herniates outside the fetal abdominal cavity, is this normal?

Answer 30

Yes, it will return to the abdomen by 12 weeks

Question 31

Defect at the base of the cord where the abdominal contents herniate into the umbilical cord.

Answer 31

Omphalocele

Question 32

What lab value is increased with an omphalocele?

Answer 32

MSAFP

Question 33

A small omphalocele containing bowel only has a higher association of what?

Answer 33

Chromosomal abnormality

Question 34

What 4 things need to be assessed when there is an omphalocele?

Answer 34

1. Is there a membrane surrounding the contents? 2. Is the cord at the center of the mass? 3. What organs are present in the omphalocele? 4. Is there ascites?

Question 35

A defect in abdominal wall to the right of the umbilical cord insertion

Answer 35

Gastroschisis

Question 36

Bowel freely floating in the amniotic fluid with no covering membrane

Answer 36

Gastroschisis

Question 37

Missing limbs or club feet, abdominal content may be outside the body cavity, short or absent cord

Answer 37

Body stock anomaly

Question 38

Absent bladder with a soft tissue anterior mass

Answer 38

Bladder exstrophy

Question 39

The rectum and urogenital sinus develop from what primitive structure?

Answer 39

The cloaca

Question 40

“Double bubble” appearance

Answer 40

Duodenal atresia

Question 41

What is duodenal atresia usually associated with?

Answer 41

Trisomy 21

Question 42

Obstruction of small bowel with meconium

Answer 42

Meconium ileus

Question 43

T/F on ultrasound, bowel should be more echogenic than bone

Answer 43

False. It should be the same echogenicity as bone

Question 44

Inflammation of the peritoneum that appears as echogenic reflectors throughout the bowel

Answer 44

Meconium peritonitis

Question 45

Dilation of the umbilical vein after it enters the fetal abdomen

Answer 45

Umbilical vein varix

Question 46

Echogenic or hyperechoic focus +/- shadowing in the fetal liver

Answer 46

Hepatic calcification