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OB-Hagen > chapter 61 fetal thorax > Flashcards

chapter 61 fetal thorax Flashcards

1
Q

single most important determinant for fetal viability

A

adequacy of pulmonary development

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2
Q

the major reason why fetuses younger than 24 weeks gestation are generally nonviable

A

pulmonary immaturity

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3
Q

breathing movements that occur before birth result in

A

aspiration of fluid into the lungs

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4
Q

the lungs at birth are about ____ filled with fluid from amniotic cavity

A

half-way filled

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5
Q

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

A
  1. through the nose/mouth
  2. into pulmonary capillaries
  3. into the lymphatics and pulmonary vessels
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6
Q

normal thoracic cavity is symmetric and ____ shaped

A

bell shaped

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7
Q

the lungs serve as lateral borders for the hear and lie ____ to the diaphragm

A

superior

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8
Q

the diaphragm can be seen as a _______ curvilinear margin

A

smooth hypoechoic/sonolucent

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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 of thoracic cavity(TC) and abdominal cavity(AC) is ______ throughout pregnancy

A

constant

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11
Q

oligohydramnios can result in _______

A

pulmonary hypoplasia

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12
Q

thoracic circenference is measured in the ____ plane at the level of the _____

A

transverse

4 chamber heart

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13
Q

a fetus that has a significantly narrower chest diameter may have _____

A

asphyxiating thoracic dystrophy

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14
Q

the majority of the heart is positioned in the midline and ____

A

left

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15
Q

the apex of the heart should be directed toward the ____

A

spleen(left)

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16
Q

detection of abnormal position of the heart may indicate:

A
  • chest mass
  • pleural effusion
  • cardiac malformation
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17
Q

fetal lungs appear:

A

homogeneous with moderate echogenicity

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18
Q

fetal lungs: echogenicity _____ as pregnancy progresses

A

increases

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19
Q

fetal breathing becomes more prominent in the ____

A

2nd and 3rd trimesters

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20
Q

a matrue fetus spends almost _____ of its time breathing

A

1/3

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21
Q

color doppler may be used to detect fetal breathing through ___

A

the nostrils

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22
Q

when evaluating fetus for lung mass, you must note:

A
  • position of heart
  • orientation of cardiac axis
  • measurement of thoracic circumference
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23
Q

deviation of heart from the normal axis may suggest presence of

A

intrathoracic mass

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24
Q

caused by a decrease in the number of lung cells, airways, and alveoli

A

pulmonary hypoplasia

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25
Q

pulmonary hypoplasia results in

A

decreased organ size and weight, small undeveloped lungs

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26
Q

pulmonary hypoplasia most commonly occurs from

A

prolonged oligohydramnios or secondary to small thoracic cavity resulting from structural/chromosomal abnormality

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27
Q

_____ abnormalities may result in lethal pulmonary hypoplasia

A

kidney

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28
Q

abnormalities that may cause pulmonary hypoplasia

A
  • cardiac defects
  • skeletal dysplasias
  • CNS disorders
  • Trisomy
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29
Q

________ pulmonary agenisis or hypoplasia is rare

A

unilateral

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30
Q

every fetus with mediastinal shift and chest mass, the differential should include

A

absent lung

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31
Q

prognosis for pulmonary hypoplasia: ____% die after birth

A

80%

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32
Q

severity of pulmonary hypoplasia depends on

A

when it occurred during pregnancy

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33
Q

thoracic circumference below the ____ percentile suggests pulmonary hypoplasia

A

5th

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34
Q

echo free masses that replace normal lung parenchyma

A

cystic lung masses

35
Q

most common lung cyst

A

bronchogenic cyst

36
Q

cyst that lacks any communication with the trachea or bronchial tree

A

bronchogenic cyst

37
Q

bronchogenic cysts typically occur in the _____ and are ____ to the diaphragm

A

mediastinum or lung

inferior

38
Q

accumulation of fluid in the pleural cavity

A

pleural effusion

39
Q

most common reason for pleural effusion

A

chylothorax

40
Q

occuring as a right-sided unilateral collection of fluid secondary to malformed thoracic duct

A

chylothorax

41
Q

______ often accompanies chylothorax resulting from esophageal compression

A

hydramnios

42
Q

pleural effusion is also known as

A

hydrothorax

43
Q

pleural effusion rarely is seen before ___

A

15 weeks gestation

44
Q

pleural effusion may be seen before 15 weeks when it is associated with

A

turner or downs syndrome

45
Q

mortality rate of pleural effusion

A

50%

46
Q

prognosis with pleural effusion is poorer when associated with

A

hydrops

47
Q

echo-dense/hyperechoic masses in the lung tissue

A

solid lung masses

48
Q

extra lobe of lung separated from the normal tracheobronchial tree

A

pulmonary sequestration

49
Q

pulmonary sequestration most likely occurs from

A

separate outpouching of foregut

separation of a segment of developing lung from the tracheobroncial tree

50
Q

pulmonary sequestration lung tissue is ___

A

nonfunctioning

51
Q

pulmonary sequestration usually occurs on the ___ side

A

left

52
Q

pulmonary sequestration rarely occurs ____

A

below diaphragm

53
Q

intralobar sequestration has a ____ prognosis

A

highly favorable

54
Q

extralobar sequestration has a ___ prognosis

A

poor

55
Q

extralobar sequestration poor prognosis is because of

A

associated anomaies and hydrops

56
Q

multicystic mass in lung that may communicate with bronchial tree

A

Congenital Cystic Adenomatoid Malformation (CCAM)

57
Q

one of the bronchopulmonary foregut malformations

A

CCAM

58
Q

most lesions in CCAM are ___

A

unilateral

59
Q

Forms of CCAM

A
  1. type 1–Macrocystic
  2. type 2–Macrocystic with microcystic components
  3. microcystic
60
Q

type 1 of CCAM cyst size:

A

single or multiple cysts measuring >2cm and up to 10cm

61
Q

type 2 of CCAM cyst size:

A

2-10cm and multiple cysts >1cm

62
Q

type 3 CCAM looks like

A

bulky, large, echo-dense masses of entire lung lobe

may cause mediastinal structures to shift

  • lung compression
  • hydrops
  • hydramnios secondary to esophageal compression
63
Q

type 1 CCAM has a ___ prognosis

A

favorable

64
Q

type 2 and 3 CCAM have _____ prognosis

A

poor

65
Q

Results from focal obliteration of a segment of the bronchial lumen

A

congenital bronchial atresia

66
Q

congenital bronchial atresia is more common in the ____ lobe

A

left upper lobe

67
Q

congenital bronchial atresia appears as:::

A

an echogenic pulmonary mass

68
Q

herniation of abdominal viscera into the thoracic cavity/chest

A

Congenital diaphragmatic hernia(CDH)

69
Q

congenital diaphragmatic hernia results from

A

congenital defect in fetal diaphragm

70
Q

congenital diaphragmatic hernia occurs where?

A

posterior aspect of diaphragm

71
Q

most common type of diaphragmatic defect

A

herniation through Foramen of Bochdalek

72
Q

Foramen of Bochdalek occurs ____ and _____ in the diaphragm

A

posterior and lateral

73
Q

foramen of bochdalek accounts for more than _____% of defects

A

90%

74
Q

foramen of bochdalek usually occurs on the ____ side

A

left side of diaphragm

75
Q

_____ may be seen in throacic cavity from foramen of bochdalek

A

bowel loops

76
Q

how would you distinguish bowel vs mass?

A

peristalsis

77
Q

Diaphragmatic herniation that is anterior and medial

A

foramen of Morgagni

78
Q

hernias on the right side of the diaphragm allow ____ _____ ______ to enter the chest

A

liver, gallbladder, intenstines

79
Q

hydrops is not usually present with ______ sided CDH

A

left sided

80
Q

left-sided CDH sonographically appears:

A
  • stomach in the chest
  • small right lung
  • small left ventricle of heart
81
Q

right-sided CDH sonographically appears:

A
  • liver appears in chest

- heart deviated to the left

82
Q

poor prognosis in CDH if

A

detected before birth

  • stomach in chest
  • left side of heart undeveloped
  • congenital heart disease present
83
Q

primary cause of death with CDH

A

pulmonary hypopasia

84
Q

associated anomalies with CDH:

A
  • cardiac & CNS malformations
  • renal anomalies
  • vertebral defects
  • pulmonary hypoplasia
  • facial clefts
  • trisomy 18 & 21

OB-Hagen (17 decks)

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