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OB2 > Ch. 61 > Flashcards

Ch. 61 Flashcards

1
Q

__ is the single most important determine for fetal viability

A

Adequacy of pulmonary development

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2
Q

__ is the major reason fetuses younger than 24 weeks are generally considered nonviable

A

Pulmonary immaturity

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3
Q

Breathing movements that occur before birth results in _

A

Aspiration of fluid into the lungs

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4
Q

The lungs at birth are about half filled with

A

Fluid from the amniotic cavity

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5
Q

The fluid in the lungs at birth clears via 3 routes:

A

Nose and mouth
Into pulmonary capillaries
Into lymphatic and pulmonary vessels

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6
Q

Normally the thoracic cavity is

A

Symmetric and bell shaped

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7
Q

The lungs serve as __ for the heart, and lie __ to the diaphragm

A

Lateral borders

Superior

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8
Q

The diaphragm can be seen as __ between the fetal liver and lungs

A

A smooth hypoechoic muscular curvilinear margin

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9
Q

Normally the fetal thorax is slightly __ than the abdominal cavity

A

Smaller

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10
Q

The ratio [TC:AC] __ throughout pregnancy

A

Remains constant

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11
Q

Extreme variations in thoracic size should signal

A

Further investigation for other anomalies

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12
Q

___ can result in pulmonary hypoplasia, which may cause __

A

Oligohydramnios

Overall reduction in the thoracic size

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13
Q

Thoracic circumference measurements are made in the __ plane at the level of __

A

Transverse

4 chamber heart

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14
Q

A fetus that has significantly narrower chest diameter may have

A

Asphyxiating thoracic dystrophy

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15
Q

Sever syndromes are associated with asphyxiating thoracic dystrophy including

A

Dwarfism

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16
Q

The majority of the heart is positioned in the

A

Midline and left chest

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17
Q

The apex of the heart should be directed

A

Toward the spleen (left)

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18
Q

It is important to document sonographically the position of the

A

the heart

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19
Q

Detection for abnormal position of the heart may indicate the presence of

A

Chest mass
Pleural effusion
Cardiac malformation

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20
Q

Fetal lungs appear

A

Homogeneous with moderate echogenicity

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21
Q

Echogenicity of the fetal lungs __ as pregnancy progresses

A

Increases

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22
Q

Fetal breathing becomes ___ in the 2nd & 3rd trimesters

A

More prominent

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23
Q

A mature fetus spends almost __ of its time “breathing”

A

1/3

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24
Q

Color doppler may be used to detect __, however it is not a well-recognized practice

A

fetal breathing through the nostrils

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25
Q

When evaluating the fetus for a lung mass the following should be assessed

A

Position of the fetal heart
Orientation of the cardiac axis (normal is 45 degree angle pointing left)
Measurement of the thoracic circmference

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26
Q

Deviation from the normal cardiac axis may suggest the presence of

A

an intrathoracic mass

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27
Q

Thoracic circumference measurements estimate ___& may predict ___

A

the size of the thoracic cavity

secondary pulmonary hypoplasia

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28
Q

When the heart position & axis vary from the normal position:

A

look closely for any abnormalities that may be causing the displacement such as pleural effusion or diaphragmatic hernia

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29
Q

Lungs may not grow or develop properly with

A

oligohydramnios

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30
Q

A mass within the throacic cavity may have ___ on lung development. The heart may be displaced & the lungs may be __. These effects may lead to __

A

detrimental effects
compressed and destroyed
pulmonary hypoplasia

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31
Q

Pulmonary hypoplasia is caused by __ and results in __

A

a decrese in the number of lung cells, airways, and alveoli

decrease in organ size and weight

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32
Q

Reduction in lung volume results in __

A

small inadequately developed lungs

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33
Q

Pulmonary hypoplasia most commonly ocurs from __ or secondary to __

A

prolonged oligohydramnios

small thoracic cavity as a result of structural or chromosomal abnormality

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34
Q

Kidney abnormalities may result in __

A

lethal pulmonary hypoplasia

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35
Q

Kindey abnormalities that may result in lethal pulmonary hypoplasia

A 
▪Bilateral renal agenesis
▪Bilateral multicystic kidney disease
▪Severe renal obstruction
▪Unilateral renal agenesis with contralateral multicystic kidney development
▪Severe obstruction
▪Infantile polycystic kidney disease
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36
Q

Pulmonary hypoplasia may occur in fetuses with

A

severe IUGR & early rupture of membranes

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37
Q

Masses within the thoracic cavity may lead to

A

Pulmonary hypoplasia

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38
Q

Abnormalities that can cause pulmonary hypoplasia are

A

▪Cardiac defects
▪Some skeletal dysplasias
▪CNS disorders
▪Chromosomal Trisomies

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39
Q

A small percentage of infants have pulmonary hypoplasia without

A

any fetal or uterine problems

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40
Q

_ pulmonary agenesis or hypoplasia is rare, often associated with __

A

Unilateral

other fetal abnormalities

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41
Q

An absent lung should be considered a differential diagnosis of every fetus with

A

mediastinal shift and apparent chest mass

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42
Q

Prognosis of pulmonary hypoplasia

A

grave

80% die after birth

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43
Q

Severity of pulmonary hypoplasia depends on

A 
▪when pulmonary hypoplasia occured during pregnancy
▪severity
▪duration
Other contributing factors: 
▪Pulmonary fluid dynamics
▪Fetal breathing movements
▪Hormonal influences
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44
Q

Various methods are used to determine the presence of pulmonary hypoplasia

A 
▪thoracic measurements 
▪Various lung measurements
▪Estimation of lung volume
▪Doppler studies of pulmonary arteries
▪Assessment of fetal breathing activity
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45
Q

A thoracic circumference below the _____percentile suggests the possibility of pulmonary hypoplasia

A

5th

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46
Q

Cystic Lung Masses

A

Echo free masses that replace normal lung parenchyma

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47
Q

Cystic lung masses vary in __

A

size, ranging from small isolated lesions to large cystic masses

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48
Q

Cystic lung masses may cause

A

notable shifts of intrathoracic structures

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49
Q

Simple cysts may be

A

surgically removed after delivery

50
Q

Most common lung cyst detected prenatally

A

Bronchogenic cysts

51
Q

Bronchogenic cysts occur as a result of

A

abnormal budding of the foregut

52
Q

Brochogenic cysts lack

A

any communication with the trachea or bronchial tree

Isolated

53
Q

Bronchogenic cysts typically occur within the

A

mediastinum or lung

54
Q

Bronchogenic cysts infrequently found

A

inferior to the diagram

55
Q

Sono appearance of bronchogenic cysts

A
  • Appear as small circumscribed masses
  • No evidence of mediastinal shift or heart failure
  • Amniotic fluid within normal range
56
Q

Accumulation of fluid within the pleural cavity

A

Pleural effusion

57
Q

Pleural effusion may appear as

A

an isolated lesion or secondary to multiple fetal anomalies

58
Q

Most common reason for pleural effusion

A

Chylothorax

59
Q

Chylothorax

A
  • Occurring as a right sided unilateral collection of fluid secondary to malformed thoracic duct
  • Hydramnios often accompanies chylothorax resulting from esophageal compression
60
Q

Pleural effusion can be

A

unilateral or bilateral

61
Q

Pleural eeffusion may result from

A

immune [Rh isoimmunization] or nonimmune causes or from congestive heart failure

62
Q

Effusions may also occur in fetuses with:

A

Chromosomal abnormalities (21) & cardiac mass

63
Q

Other reasons for pleural effusions

A 
▪Lymphangietctasia 
▪Cystic adenomatoid malformations
▪Bronchopulmonary sequestration
▪Diaphragmatic hernia
▪Hamartoma
▪Atresia of pulmonary vein
▪Unknown causes
64
Q

Sono findings of pleural effusion

A

▪Echo-free peripheral masses on one or both sides of the fetal heart
▪Conform to the thoracic cavity & often compress the lung tissue
▪Lung appears to float in the fluid

65
Q

Pleural effusions are rarely seen before _, except when __

A

15 weeks gestation associated with Down or Turner syndrome

66
Q

With pleural effusion, Compression of lung parenchyma may cause __, often represents __

A

pulmonary hypoplasia

life threatening consequences for neonate

67
Q

The presence of pleural effusion may cause:

A

▪a shift in medistinal structure
▪Compression of the heart
▪Inversion of the diaphragm

68
Q

Mortality rate of pleural effusion

A

approx. 50%

69
Q

Prognosis of pleural effusion

A

poorer with associated hydrops

70
Q

When pleural effusion is large

A

▪Lung development is impaired

▪Pulmonary hypoplasia may result

71
Q

Solid lung masses appear as

A

echo-dense (hyperechoic) masses in the lung tissue

72
Q

Pulmonary sequestration and certain types of cystic adenomatoid malformations (CCAMs) appear as

A

solid masses

73
Q

Pulmonary sequestration

A

supernumerary lobe of the lung (extra lung tissue) separated from the normal tracheobronchial tree

74
Q

Intralobar pulmonary sequestration

A

There is extra lung tissue present within the pleural lung sac

75
Q

Extralobar pulmonary sequestration

A

Lung tissue is connected to the inferior border of the lung within its own pleural sac

76
Q

Pulmonary sequestration most likely develops from either

A

A separate outpuching of foregut

Separation of a segment of developing lung from the tracheobronchial tree

77
Q

with pulmonary sequestration the extra lung tissue is

A

non-functional & receives blood supply from systemic circulation

78
Q

Sono findings of pulmonary sequestration

A

▪Echogenic solid mass resembling lung tissue, usually in the lower lobe of the lung
▪Usually on the left side
▪Rarely occurs below the diaphragm

79
Q

Pulmonary sequestration is associated with

A 
▪Hydrops
▪Polyhydramnios
▪Diaphragmatic hernia
▪Gastrointestinal anomalies
▪Lung anomalies [pulmonary hypoplasia]
80
Q

Prognosis of pulmonary sequestration

A

▪Intralobar sequestration has a highly favorable prognosis
▪Extralobar sequestration carries a poor prognosis
Becuase of associated anomalies and hydrops

81
Q

Congenital Cystic Adenomatoid Malformation([CCAM)

A

multicystic mass within the lung Consists of primitive lung tissue & abnormal bronchial and bronchial-like structures

82
Q

CCAM is one of the

A

bronchopulmonary foregut malformations

83
Q

CCAM lesions may involv

A

▪One or more lobes of lung
▪Entire lung
▪Be bilateral

84
Q

CCAM malformations may

A

communicate with the bronchial tree

85
Q

With CCAM, cysts within the mass may be

A

large or small

86
Q

Texture of CCAMs

A

Varies:
solid
cystic
mixed

87
Q

With CCAM, most lesions are

A

unilateral and do not favor either lung

88
Q

3 forms of CCAM

A

Type 1- macrocystic
Type 2- macrocystic w/ microcystic components
Type 3- Microcystic

89
Q

CCAM type 1

A

Macrocystic
•One or more large cyst replaces normal lung tissue
•Single or multiple cysts measuring 2cm up to 10 cm

90
Q

CCAM type 2:

Anomalies may include:

A

Macrocystic with microcystic components
•Lesions consist of multiple small cysts <1cm
•Associated with fetal &/or chromosomal abnormalities in 25% of cases:
Renal agenesis
Pulmonary anomalies
Diaphragmatic hernia

91
Q

CCAM Type 3

A 
Micocystic
•Bulky, large, noncystic lesions
•Appear as echo-dense [hyperechoic] masses of the entire lung lobe
•When mediastinal structures shift
oLung compression may occur
oHydrops may develop
•Hydramnios may be seen secondary to esophageal compression
oPreventing normal fetal swallowing
92
Q

When a cystic or solid lung mass is identified the sonographer should attempt to

A

▪Determine the number & size(s) of the cystic structure(s)
▪Check for presence or absence of a mediastinal shift
▪Identify & assess the size of the lungs
▪Look for fetal hydrops
▪Exclude cardiac masses
▪Search for other fetal anomalies

93
Q

Progsis of CCAM

A

the type of lesion
type 1- favorable outcome
type 2 &3- poor prognosis

94
Q

Smaller cysts= _ prognosis

95
Q

Congenital Bronchial Atresia

A

Rare
Results from focal obliteration of a segment of the bronchial lumen
Most common in left upper lobe
Appears as an echogenic pulmonary mass lesion

96
Q

Normally, the diaphragm should appear as a

A

curvilinear hypoechoic structure coursing anteriorly to posteriorly

97
Q

The fetal stomach & liver should be identified _to the diaphragm

A

caudal/ inferior

98
Q

The fetal lungs and heart should be identified _to the diaphragm

A

Cephalad/ superior

99
Q

Failure to see normal relationships to the diaphragm indicates

A

diaphragmatic defects

100
Q

Congenital Diaphragmatic Hernia [CDH]

A

Herniation of the abdominal viscera into the chest

101
Q

CDH results from

A

congenital defect in the fetal diaphragm

102
Q

Most posterior aspect of the diaphragm:

A

forms last

most commonly defective

103
Q

Hernia permits abdominal organs to

A

enter the chest

104
Q

Herniation through Foramen of Bochdalek

A

Most common type of diaphragmatic defect
▪Occurs posteriorly & laterally in the diaphragm
•This abnormality positions the heart & mediastinal structures to the right side of the chest
•Look for stomach, portions of small & large intestines, left lobe of liver & spleen in thoracic cavity
•bowel loops may be seen within the thoracic cavity

105
Q

How would you distinguish loops of bowel vs a mass

A

bowel has peristalsis

106
Q

Herniation through foramen bochdalek accounts for more than

A

90% of diaphragmatic defects

107
Q

Herniation through foramen bochdalek usually occurs on the

A

left side of the diaphragm

108
Q

Diaphragmatic herniation through the foramen of Morgagni

A

Anteriorly & medially
May communicate with the pericardial sac
The heart & stomach may be normally positioned

109
Q

With Diaphragmatic herniation through the foramen of Morgagni, herniation is on the _, allowing

A

right side of the diaphragm

the right sided abdominal viscera to enter the chest (liver, GB, intestines)

110
Q

Herniated abdominal organs cause

A

lung compression

111
Q

With Diaphragmatic herniation through the foramen of Morgagni Size of defects can vary. Range from

A

small to large to complete absence of both diaphragms

Smaller defects are more difficult to diagnose in utero

112
Q

Hydrops is usually not present with _ CDH

A

left sided unless associated fetal malformations are present

113
Q

with hernias, Pulmonary arteries become _
Results in_
After birth, _

A

hypertrophied & thickened
Results in pulmonary HTN
After birth, leads to persistent fetal circulation

114
Q

B/L hernias are

A

very unusual
more difficult to detect
Cardio-mediastinal shift may not be present

115
Q

Sonographically:

Left-sided CDH

A
  • Intrathoracic stomach
  • Displaced cardiac apex
  • Cardio-mediastinal shift [critical in making diagnosis]
  • Intrathoracic liver
  • Small right lung
  • Small left ventricle of heart
  • Evaluate for chromosomal abnormalities
116
Q

Sonographically:

Right-sided CDH

A 
•Liver appears in the chest
•Possibly collapsed bowel
•Heart deviated to the left
•Abnormal stomach alignment
•Respirations may be severely compromised
     •May result in death 
      of the newborn
117
Q

CDH prognosis

A 
Poor prognosis if:
•Detected before birth
•Stomach is found in the ches
•Left side of heart is undeveloped
•Congenital heart disease is present

▪

118
Q

With CDH, Primary cause of death is

A

pulmonary hypoplasia

119
Q

With CDH, if __Survival rate is low

A

diagnosis is made before 25 weeks & polyhydramnios is present

120
Q

Anomalies associated with CDH

A 
▪Cardiac malfomations
▪CNS malformations
▪Renal anomalies
▪Vertebral defects
▪Pulmonary hypoplasia
▪Facial clefts
▪Trisomy 18 & 21

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