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OBGYN 2 > M7: Fetal Chest Pathology > Flashcards

M7: Fetal Chest Pathology Flashcards

(66 cards)

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1
Q

How does the diagram appear on US

A

Hypoechoic linear structure b/w the lungs and abdomen

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2
Q

Why is the diaphragm hypo?

A

There’s no air in the lungs, and some fluid

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3
Q

When is the diaphragm easiest to see

Is what view?

A

Later gestation

Parasagittal scans

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4
Q

Echogenicity of fetal lung tissue

Echgenicity compared to liver

A

Homogenous

Isoechoic
Hyperechoic

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5
Q

What do we assess when scanning the heart (in general)

A

4 chambers
That it occupies 1/3 of the fetal chest
Apex points to the left w/ axis at about 45 degrees

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6
Q

What must you always do when scanning the heart

A

Zoom and sector down

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7
Q

What is pulmonary hypoplasia

Can it be lethal

A

When one or both lungs are underdeveloped

Yes

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8
Q

Fetuses under how many weeks are not considered viable w/ pulmonary hypoplasia

A

24

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9
Q

Which drugs given in utereo can help w/ the exchange of 02

A

Steroids

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10
Q

Possible causes of pulmonary hypoplasia

A

Restricted chest cage w/ skeletal dysphasia
Decrease amniotic fluid
Chest masses
Pleural

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11
Q

Most common cause of pulmonary hypoplasia

A

Lack of fluid, causes by PROM and genitourinary anomalies

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12
Q

US methods to predict pulmonary hypoplasia

A
  • measure (outer to outer) the TRX chest circumference at the level of the 4CH view
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13
Q

When would you not measure outer-outer when doing a chest circumference measurement

A

If the fetus has Edema/hydrops

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14
Q

What is CCAM/CPAM

A

Congenital cystic adenomatoid malformation / congenital pulmonary airway malformation

It’s a type of hamartoma that usually effects 1 lobe of the lung and communicates w/ the tracheobronchial tree

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15
Q

3 classifications of CPAM

A

Type 1, 2, and 3

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16
Q

CPAM is associated with which conditions

A

Hydrops
Pulmonary hypoplasia
Polyhydramnious

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17
Q

If the CPAM is large what might it cause

A

Mediastinal shift

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18
Q

What is a hamartoma

A

Overgrowth of tissue

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19
Q

Describe type 1 CPAM

A

Macrocystic w/ cysts >2cm

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20
Q

Describe type 2 CPAM

A

Macro and microcystic, cysts are smaller than 1.5 cm

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21
Q

Describe type 3 CPAM

A

Microcystic, will see multiple interfaces and lungs will be echogenic

The heart will also be very displaced

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22
Q

Prognosis for CPAM

A

-Depends on mediastinal shift and hydrops

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23
Q

Can CPAM disappear on its own

A

Yes

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24
Q

Is intervention usually need for CPAM

A

No, unless hydrops in seen

But cysts may be drained or masses may be surgically resected

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25
DDX for CPAM
Sequestration Bronchogenic cyst Congenital diaphragmatic hernia (CDH)
26
What is pulmonary squestation
A mass of ectopic pulmonary tissue, covered by its own pleura
27
Does pulmonary squestation tissue communicate w/ the bronchial tree
No
28
Where does pulmonary squestation get its blood supply
An ectopic arterial supply that branches off the descending AO Venous drainage is to the systemic system, not the pulmonary veins
29
Does pulmonary squestation occur more commonly in the L or R lung
Left
30
US appearance of pulmonary squestation
Uniform hyperechoic mass | Look for artery feeding off the AO
31
pulmonary squestation is associated w/ which conditions
Hydrops and polyhydramnious, secondary to the mass effect
32
Prognosis for pulmonary squestation
Good unless associated w/ hydrops
33
Does pulmonary squestation often resolve on it own
Yes
34
Ddx for pulmonary squestation
CPAM III
35
What’s the mass effect w/ pulmonary squestation
Mass pushing on the heart and mediastinum
36
How can you differentiate b/w pulmonary squestation and CPAM on US
pulmonary squestation will have the branch feeding off the artery
37
What is a bronchogenic cyst
A cyst in the lung, lined w/ bronchial epithelium
38
Bronchogenic cysts are associated w/ what anomalies
TE fistula | Lung sequestration
39
US appearance of Bronchogenic cysts
Uni/multiocular cyst | Mediastinal shift
40
DDX for Bronchogenic cysts
CPAM type 1
41
Describe a diaphragmatic hernia 2 types
A defect in the diaphragm that allows the abdo contents to herniate up into the chest 1. foramen of bochdalek 2. foramen of maorgagni
42
Which structures can herniate into the chest
Intestines Stomach Liver
43
Which side do diaphragmatic hernias usually occur
Left
44
prognosis for diaphragmatic hernia
good if theres no other anomalies
45
describe a foramen of bochdalek hernia
- posterolateral defect in the diaphragm, more commonly on the L side - can be a hole in the diaphragm, or it can be intact but weak
46
what may you see w/ a left foramen of bochdalek hernia
- stomach or intestines in chest (look for parastalsis) | - lung w/ absence of diaphragm + mediastinal shift
47
what may you see w/ a right foramen of bochdalek hernia
- liver in chest which is hard to tell apart from the lungs (use colour) - may not see mediastinal shift as much
48
a mediastinal shift is always to what side
right
49
describe a foramen of morgagni hernia it usually involves which organ
-partial or complete absence of central diaphragm (think midline b/c of gag reflex) liver
50
is there a mediastinal shift w/ a foramen of morgagni hernia
yes, but heart is still on L side
51
which type of diaphragmatic hernia is more common
bochdalek
52
key US sign of CDH other signs
mediastinal shift cystic components in fetal chest diaphragm not intact on SAG scan stomach not seen in the abdo
53
what is the cystic component in the fetal chest w/ CDH is it hard to see
the stomach, or bowel yes, can only see if fetus has been swallowing
54
what does CDH cause
pulmonary hypoplasia
55
is pleural fluid in the lungs always abnormal what can happen if its a large collection
yes, can cause pulmonary hypoplasia
56
define hydrops
fluid in 2 body cavities, or fluid in 1 cavity w/ edema
57
2 types of pleural effusion describe them
serous: a sign of hydrops associated w/ down and turners hypoechoic chylous: collection of lymphatic fluid (appears white) maybe associated w/ polyhydramnios both may displace lungs towards midline
58
US appearance of pleural effusion
- cystic collection above the diaphragm - unilateral - possible mediastinal shift - may invert diaphragm
59
Tx for pleural effusion when is this done
hydrothorax and chylothorax: - thoracentesis - shunt fluid into abdo or amniotic cavity - no treatment, may resolve on its own treatment is done if the fetus is compromised
60
describe a tracheal atresia US appearance
congenitally non-patent airway Enlarged lungs and airways flat diaphragm ascites w/ polyhydramnios
61
is a sm amount of amniotic fluid naturally produced in the fetal lungs
yes
62
describe an esophageal atresia US appearance
congenitally absence of a segment of the esophagus small or no stomach bubble - depends on if a TE fistula is present cystic strucutre in neck that disappears polyhydramnios fetal vomiting
63
esophageal atresia is associted w/ which conditions
TE fistula down syndrome VACTERL heart defects
64
list some chest wall shape abnormalities what can they cause
narrow long bell shaped dwarfism pulmonary hypoplasia
65
describe ectopia cordis
an anterior chest wall fusion defect that causes the heart will be outside the chest cavity
66
describe the pentalogy of centrell
5 defects involved: SOAPE ``` sternum anterior diaphragm pericardium ectopia cordis w/ heart defects omphalocele ```

OBGYN 2 (15 decks)

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