Ch. 60 The Fetal Thorax Flashcards

1
Q

what is the most important determinant for fetal viability?

A

pulmonary development

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2
Q

at birth fluid in the lungs is expelled through 3 routes. what are these routes?

A
  1. mouth and nose
  2. pulmonary capillaries
  3. lymphatics and pulmonary vessels
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3
Q

what 3 planes is the thorax examined in?

A

transverse, coronal, parasagittal

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4
Q

a fetus with a narrow chest diameter may have what?

A

asphyxiating thoracic dystrophy

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5
Q

the apex of the heart should be directed towards ___________ at an axis that is _____ degrees from midline

A

left chest wall

45

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6
Q

the base of the heart lies _______ to the diaphragm

A

horizontal

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7
Q

why is the location of the heart important?

A

to indicate presence of chest mass, pleural effusion, or cardiac malformation

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8
Q

when will fetal breathing become more prominent?

A

second and third trimesters

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9
Q

where can color doppler detect fetal breathing?

A

through the nostrils

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10
Q

4 reasons the lungs will not develop properly

A
  1. oligohydramnios
  2. small chest cavity
  3. balance between tracheal and airway pressure and fluid volume is inadequate
  4. fetus unable to practice breathing movements
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11
Q

what causes pulmonary hypoplasia?

A

decrease in lung cells, airways, and alveoli resulting in decreased organ size and weight

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12
Q

occurs from prolonged oligohydramnios or is secondary to a small thoracic cavity

A

pulmonary hypoplasia

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13
Q

4 masses that cause pulmonary hypoplasia

A
  1. pleural effusion
  2. diaphragmatic hernia
  3. cystic adenomatoid malformation
  4. bronchopulmonary sequestration
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14
Q

most common lung cyst detected prenatally

A

bronchogenic cyst

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15
Q

sonographic appearance of bronchogenic cyst

A

small circumscribed mass without mediastinal shift or heart failure

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16
Q

fluid within the pleural cavity that appears as an isolated lesion is called what?

A

pleural effusion or hydrothorax

17
Q

sonographic appearance of pleural effusion

A

echo-free peripheral masses on one or both sides of fetal lung

18
Q

compression of lung may cause what?

A

pulmonary hypoplasia (which leads to life-threatening consequences for neonate)

19
Q

what is pulmonary sequestrian?

A

supernumerary lobe of lung separated from the normal tracheobronchial tree

20
Q

sonographic appearance of pulmonary sequestrian

A

echo-dense solid mass resembling lung tissue

21
Q

extralobar defects occur on the _____ side and are _______ or _______ shaped

A

left
cone
triangular

22
Q

intralobar lesions are _____ shaped

A

spherical

23
Q

what is congenital cystic adenomatoid malformation

A

multicystic mass within the lung consisting of primitive lung tissue and abnormal bronchial structures

24
Q

what is the first form of cystic adenomatoid malformation?

A

CCAM type I: one or more large cysts replace normal lung tissue

25
Q

what is the second form of cystic adenomatoid malformation?

A

CCAM type II: lesions consist of multiple small cysts

26
Q

what is the third form of cystic adenomatoid malformation?

A

CCAM type III: bulky, large, noncystic lesions appearing echo-dense

27
Q

what 6 sonographic findings should you attempt when you find a lung mass

A

Determine number and size of cystic structures
Check for presence or absence of a mediastinal shift
Identify and assess lung size
Look for fetal hydrops
Exclude cardiac masses
Search for other fetal anomalies

28
Q

what is congenital bronchial atresia

A

rare pulmonary anomaly that results from obliteration of a segment of the bronchial lumen

29
Q

where is congenital bronchial atresia commonly found?

A

left upper lobe

30
Q

when does the diaphragm form

A

between 6th and 14th week

31
Q

the fusion of what 4 structures causes the diaphragm to form

A
  1. septum transversum
  2. pleuroperitoneal membranes
  3. dorsal mesentery of esophagus
  4. body wall
32
Q

congenital diaphragmatic hernia is

A

a herniation of the abdominal viscera into the chest that results from a congenital defect in the fetal diaphragm

33
Q

the most common type of diaphragmatic defect occurs through

A

the foramen of Bochdalek posteriorly and laterally

34
Q

if a diaphragmatic hernia occurs anteriorly and medially it goes through

A

the foramen of Morgagni and may communicate with the pericardial sac

35
Q

prognosis for fetus is poor with diaphragmatic hernia is (4)

A
  1. hernia is detected before birth
  2. stomach is found in chest
  3. left heart is underdeveloped
  4. congenital heart disease is present
36
Q

6 associated abnormalities of diaphragmatic hernia

A
  1. cardiac malformations
  2. CNS malformations
  3. renal anomalies
  4. vertebral defects
  5. pulmonary hypoplasia/ face clefts
  6. chromosomal abnormalities
37
Q

what is the mortality rate for diaphragmatic hernia and why?

A

75% because of increased frequency of coexisting anomalies