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MIDS 187 > Ch 7 Chest > Flashcards

Ch 7 Chest Flashcards

1
Q

What does the normal intrathoracic contents consist of?

A

-Homogeneous, relatively symmetric lung parenchyma surrounding central heart
-Mediastinum

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2
Q

The clavicles ossify (turn into bone) as early as how many weeks?

A

8 wks

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3
Q

The scapulae ossify beginning at what week?

A

10 wks

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4
Q

Ossification of sternum begins b/w what weeks?

A

21-27 wks

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5
Q

Evaluation + assessment of fetal thorax/chest includes what?

A

-Observation of size/symmetry of bony + soft tissue elements

-Assess heart, pulmonary echotexture, diaphragm, bony elements for symmetry + chest size compared to abdomen

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6
Q

What should we be looking out for when assessing the thorax?

A

Asymmetry, mass, mass effect or mediastinal shift

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7
Q

What are the posterior elements also called?

A

Lamina

(there is only 1 anterior element)

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8
Q

Why should we examine the vertebrae?

A

For ensure there is convergence of the paired posterior ossified elements toward the nonossified spinous process + single anterior element

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9
Q

Why evaluate the posterior skin surface?

A

To rule out a break in the skin surface (associated with myelomeningocele)

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10
Q

Muscles of chest wall are hypoechoic or hyperechoic + thick or thin?

A

Hypoechoic + thin

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11
Q

List 2 reasons why soft tissues may appear thick?

A

-With fetal edema/swelling
-Due to subcutaneous fat deposits in infants of diabetic moms

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12
Q

Anterior chest wall masses (fetal breasts) can form/enlarge under the influence of what?

A

Maternal hormone stimulation

(can be seen in fetuses of either sex)

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13
Q

What type of biometry is used to rule out pulmonary hypoplasia or to assess gest age?

A

Thoracic circumference

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14
Q

How do we obtain a thoracic circumference?

A

-Outer to outer
-True TRV view, above diaphragm at level of heart

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15
Q

What would low thoracic circumference measurements indicate?

A

Decrease in lung volume (found with pulmonary hypoplasia)

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16
Q

Are all low TC/AC ratios caused by pulmonary hypoplasia?

A

No! Can just be a small thorax

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17
Q

The TRV view of chest (at level of AV valves) should show the heart taking up how much of the thorax?

A

One-third

(if it takes up more space, consider pulmonary hypoplasia + cardiomegaly)

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18
Q

Lungs begin developing in embryo as a diverticulum extending from what?

A

Tracheal bud

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19
Q

Primary bronchial buds grow laterally + become what structure?

A

Pleural cavity

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20
Q

In week 5, the bronchial buds join with the primitive trachea to form what?

A

The bronchi

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21
Q

In pseudoglandular period, the bronchi divides into secondary bronchi which forms what?

A

The lobar, segmental + intersegmental branches

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22
Q

Respiration is possible during what week due to development of terminal saccules?

A

Week 24

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23
Q

What happens in the terminal saccular period from 26 weeks to birth?

A

Saccules keep developing + increase ability of lungs to perform gas exchange

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24
Q

When is the alveloar period?

A

32 weeks to birth

(overlaps terminal saccular period)

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25
Q

When is the terminal saccular period?

A

26 weeks to birth

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26
Q

The lungs are separated by what?

A

The diaphragm

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27
Q

SF of normal lungs?

A

Homogeneous + symmetric

(compare echogenicity to liver + spleen in SAG/coronal)

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28
Q

How does the echogenicity of lungs compare to the liver?

A

Early gestation: lung is equal or slightly less of the liver

Later gesation: lung is greater than liver

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29
Q

What is the gold standard for assessing lung maturity?

A

Amniocentesis (u/s can not assess it)

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30
Q

CD imaging of lung vasculature helps rule out what?

A

Pulmonary agenesis

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31
Q

SF of diaphragm?

A

Thin, hypoechoic, dome shaped muscular band that separates abdominal cavities from thoracic cavity

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32
Q

What does the SAG plane of the upper/lower surface of the diaphragm show?

A

Upper surface: forms floor of thoracic cavity
Lower surface: roof of abdominal cavity

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33
Q

Imaging the diaphragm can help differentiate what 2 things?

A

Cystic intrathoracic masses from pulmonary origin VS intraabdominal origin

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34
Q

When in the pregnancy would fetal breathing possibly be detected by diaphragmatic motion?

A

As baby nears term

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35
Q

Location of thymus?

A

Posterior to sternum at level of great vessels in heart (anterior to AO + PA)

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36
Q

SF of thymus?

A

Hypoechoic structure

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37
Q

Do we regularly image the thymus?

A

No! Only if large pleural effusions present

(can assess when determining IUGR + predicting chorioamnionitis)

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38
Q

Location of larynx?

A

Fetal neck anterior to trachea, at level of 3rd-6th cervical vertebrae

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39
Q

When are the oropharynx + laryngeal pharynx occasionally seen?

A

When filled with fluid (see coronally)

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40
Q

Laryngeal atresia/stenosis is suspected when we see what in the trachea?

A

Persistently fluid filled trachea (wonder if there is an occlusion)

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41
Q

What is a pleural effusion?

A

Accumulation of pleural fluid in lungs

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42
Q

What is associated with pleural effusion?

A

-Hydrops (m/c)
-Congenital cardiac anomalies
-Chromosomal anomalies
-Polydactyly

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43
Q

How common are pleural effusions?

A

Common, makes up half of all intrathoracic abnormalities (will see in clinical)

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44
Q

Is a small amount of fluid in chest normal?

A

No! Should be NO fluid present

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45
Q

Is pleural effusion m/c an isolated finding?

A

Nope! M/c part of other fetal pathologic processes (m/c fetal hydrops)

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46
Q

What is fetal hydrops?

A

Excessive fluid accumulations in fetal soft tissues + body cavities

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47
Q

SF of bronchogenic cysts?

A

-Unilocular or multilocular
-Displaces mediastinal structures
-Found in lung parenchyma or mediastinum

(image looks like large, perfectly circular anechoic cyst in chest)

48
Q

Are bronchogenic cysts common?

A

Nope!

49
Q

Bronchogenic cysts often communicate directly with what?

A

Trachea or main stem bronchi

50
Q

What is pulmonary sequestration?

A

-Solid, nonfunctioning mass of lung tissue
-Located in pleural sac
-Lacks communication with tracheobronchial tree + has a systemic arterial blood supply

51
Q

How common is pulmonary sequestration?

A

Accounts for a quarter of lung lesions

52
Q

Is pulmonary sequestration m/c in males or females?

A

Males (4:1 male to female ratio)

53
Q

Location of extralobar pulmonary sequestrations?

A

Either above or below diaphragm

(has its own pleural sac + systemic venous drainage)

54
Q

SF of intralobar pulmonary sequestration?

A

Lung mass that appears spherical, homogeneous, highly echogenic + often seen at lung base or inferior to diaphragm

(image shows large very echogenic mass in lung)

55
Q

Do extralobar pulmonary sequestration massess have a good or bad prognosis?

A

Good! Can resolve spontaneously in utero

56
Q

The determination of blood supply with CD aids in diagnosis for pulmonary sequestration + what other pathology?

A

CCAM (has arterial supply originating from PA)

57
Q

Fetal edema may be limited to the neck, but is most commonly associated with what?

A

Fetal hydrops + increased soft tissue thickness

(this forms a HALO pattern around neck, thorax + abdomen)

58
Q

Nuchal area edema is associated with what?

A

-Nonimmune hydrops
-Demise
-Skeletal dysplasias

59
Q

What are cystic hygromas?

A

-Benign abnormalities of lymphatic origin occurring in 1 in 6,000 pregnancies

-Due to failure in development of normal lymphatic venous communication

60
Q

Is fetal edema usually good or bad news?

A

Bad

61
Q

Are cystic hygromas common?

A

Yes, very common in 1st trimester

62
Q

SF of cystic hygromas?

A

-Lymphatic sacs dilate
-Unilocular or multilocular cystic masses

63
Q

What is pulmonary hypoplasia?

A

Lack of development of lung

(usually secondary to lung compression, but can also result from abdominal masses)

64
Q

A small thorax of several skeletal dysplasias is associated with what?

A

Lung underdevelopment

65
Q

What is necessary for normal lung development?

A

Fluid movement due to maternal breathing + heart/body motion on chest wall

(with oligohydramnios, there is little fluid to transmit these movements which may cause pulmonary hypoplasia)

66
Q

Is oligo or polyhydramnios associated with pulmonary hypoplasia?

A

Oligo

67
Q

What is the prognosis of pulmonary hypoplasia?

A

-Depends on degree of hypoplasia (rarely primary cause of inadequate lung growth)

-Mortality is high with pulmonary insufficiencies due to inability of lungs to support extrauterine life

68
Q

What fetuses would have erythroblastosis fetalis (severe anemia) or immune hydrops?

A

Fetus whose mom has been sensitized by a blood factor histoincompatibility (typically Rh factor)

69
Q

Explain the immune reaction b/w mom + fetus in immune fetal hydrops?

A

Maternal immunoglobulin G (IgG) + fetal blood factor is not compatible

70
Q

What is the result of immune fetal hydrops?

A

Fetal morbidity + mortality

(sm amount of ascites or pericardial effusion are signs of impending organ failure)

71
Q

What can we give the mom to help protect against immune fetal hydrops?

A

RhoGam - can protect Rh-negative mom from incompatibility with future Rh-positive baby

72
Q

Degree of fetal anemia with immune fetal hydrops can be determined through what exam?

A

Amniocentesis or cordocentesis

73
Q

Is fetal hydrops m/c from immune or non-immune?

A

Non-immune

74
Q

What is nonimmune hydrops from?

A

Variety of severe fetal diseases, NOT from incompatibility of fetal/maternal blood!!

(is also usually fatal)

75
Q

SF of nonimmune fetal hydrops?

A

-Skin thickening
-Pleural + pericardial effusion
-Ascites
-Hepatomegaly + splenomegaly
-Thick placenta over 4cm (due to anemia)
-Polyhydramnios (warning sign of fetal distress)

76
Q

What is a congenital diaphragmatic hernia (CHD)?

A

Defect of diaphragm that allows contents from abdomen to migrate into thorax

77
Q

The opening into the pleuroperitoneal membrane with CHD may result in several different diaphragmatic abnormalities, what are they?

A

-Complete absence of diaphragm (uncommon)

-Protrusion of bowel through diaphragm

-Retrosternal, anteromedial herniation through foramen of Morgagni

-Posterolateral herniation through foramen of Bochdalek (M/C, over 90%), usually on left side

78
Q

What accounts for the largest amount of congenital diaphragmatic hernias?

A

Posterolateral hernias through the FORAMEN OF BOCHDALEK!!!

(dustin will ask this)

79
Q

Is left or right sided involvement more common with CHDs?

A

Left is 5x m/c

(liver helps prevent right sided herniation)

80
Q

Are CHDs m/c unilateral or bilateral?

A

Unilateral 96% (left side)

81
Q

Are CHDs m/c in men or women?

A

Men

82
Q

The majority of CHD cases are due to what?

A

Unknown causes (half occur as an isolated defect)

83
Q

Should we do an EV if we suspect a CDH?

A

Yes, early diagnosis is important as it affects the outcome

84
Q

What organs tend to move into the chest if a posterior diaphragmatic defect is present?

A

Stomach, bowel, etc.

85
Q

Cystic or solid abnormalities of the lung can stimulate CDHs?

A

Cystic - look at the abdomen to confirm absence of stomach

86
Q

Will a fetus with CDH have a larger or smaller AC measurement?

A

Smaller

87
Q

Will the heart + mediastinum shift towards or away from side of herniation?

A

Away

88
Q

Is oligo or polyhydramnios a worse sign with CDHs?

A

Polyhydramnios - pleural effusions are bad too

(the smaller the herniation = better prognosis)

89
Q

Are left or right sided hernias easier to see?

A

Left - b/c of cystic nature of stomach + ectopic presence in chest (no liver in the way)

90
Q

List anomalies that mimick CHD?

A

-CCAM
-Pulm sequestration
-Bronchogenic cyst
-Teratomas
-Neurenteric cysts
-Bronchial atresia

91
Q

Pressure from the herniated abdominal contents on the pulmonary vessels + lungs (with CDHs) can mimick an intrathoracic mass, what can this lead to?

A

Pulmonary hypoplasia

(can be bilateral despite a unilateral diaphragmatic lesion)

92
Q

Are CDHs fatal?

A

Yes, 50-80% mortality rate with 35% stillbirth rate

93
Q

If surgery is performed before how many weeks gestation can there be an improved prognosis for an CDH?

A

By 24 weeks, before lung development is complete

(it will reduce pressure + avoid pulmonary hypoplasia from forming)

94
Q

Will a liver in an abdomen survive if there is a CDH?

A

Yes, 90% survival

95
Q

What does CCAM stand for? How many types are there?

A

-Congenital cystic adenomatoid malformation
-3 types

96
Q

What is the m/c identified mass in fetal chest, when excluding diaphragmatic hernias?

A

CCAM

97
Q

Do CCAMs m/c involve a part of a lobe OR an entire lobe?

A

Entire lobe (usually unilateral)

98
Q

Which part of the lobe do CCAMs occur in?

A

Upper lobe

99
Q

What do CCAMs consist of?

A

A pathologic mass on the lung consisting of multiple cysts of different sizes

100
Q

What does type 1 CCAM consist of?

A

Single cyst or multiple large cysts (2-10cm in diameter) with a trabeculated wall + smaller cystic outpouchings

101
Q

What does type 2 CCAM consist of?

A

Multiple, uniform sized cysts (0.5-2cm in diameter)

102
Q

What does type 3 CCAM consist of?

A

-Multiple microscopic cysts (0.5-5.0mm)
-Similar to PKD
-B/c they are so small, it will appear as a single solid homogeneous echogenic mass

103
Q

80% of neonates who survive with CCAM present with what at birth?

A

Respiratory distress

104
Q

Pt’s with CCAM type 2 may have what types of associated malformations?

A

-Renal
-Cardiac
-Gastrointestinal

105
Q

Fetuses with CCAM may present with what conditions due to the compression on the lung?

A

-Hydrops
-Ascites
-Polyhydramnios

106
Q

Will a CCAM cause in increased or decrease in thoracic diameter?

A

Increase - plus inversion of diaphragm

107
Q

Which type of CCAM is worst?

A

Type 3 - is more extensive as it is solid appearing

(types 1 + 2 have better prognosis)

108
Q

Which type of CCAM is m/c?

A

Type 1

109
Q

SF of type 1 CCAM?

A

-Unilateral pulmonary/lung mass
-One or more large cysts

110
Q

SF of type 2 CCAM?

A

-Echogenic mass
-Small cysts

111
Q

SF of type 3 CCAM?

A

Solid, homogeneous echogenic mass

(worst prognosis b/c not cystic)

112
Q

During which trimester is CCAM detected?

A

2nd

113
Q

During which trimester does CCAM begin developing?

A

1st trimester

114
Q

Due to mass effect of CCAM, what do some fetuses demonstrate?

A

-Ascites
-Pleural effusion
-Hydrops
-Inversion of diaphragm

115
Q

How can CD help us differentiate a CCAM from pulmonary sequestation + diaphragmatic hernias?

A

CCAM: CD identifies arterial supply via pulmonary vessels

Sequestration + hernias: do NOT demonstrate vascularity with CD or power doppler

116
Q

Will CCAMs show flow + vascularity?

A

Yes!

117
Q

Can CCAMs disappear on its own?

A

Some can, most baby’s need operation once born

MIDS 187 (19 decks)

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