Fetal Chest (lesson 10)

Question 1

In the bony thorax, clavicles ossify as early as… ?

Answer 1

8 wks

Question 2

In the bony thorax, the scapulae ossify at… ?

Answer 2

10 wks

Question 3

The sternum begins to ossify between weeks… ?

Answer 3

21 - 27 wks

Question 4

When examining the posterior skin surface, you find a break in the skin surface - what is this associated with?

Answer 4

Myelomeningocele

Question 5

The muscles of the chest wall are which echogenicity?

Answer 5

Hypoechoic

Question 6

Diabetics mothers can cause their baby’s soft tissues to appear…

Answer 6

thick with generalized edema (swelling) due to the subcutaneous fat deposits

Question 7

Thoracic Circumference may be taken to assess… and rule out…

Answer 7

Assessing gestational age or rule out pulmonary hypoplasia

Question 8

Where is the Thoracic Circumference taken from?

Answer 8

True TRV, above the diaphragm at the level of the heart

Question 9

Thoracic Circumference is measured how?

Answer 9

Outer to outer

Question 10

If the fetal heart takes up more than 1/3 of the chest, what should be considered?

Answer 10

Pulmonary hypoplasia, or cardiomegaly

Question 11

The lungs begin development in the embryo as a _______ extending from the ________ bud.

Answer 11

diverticulum
tracheal

Question 12

The primary bronchial buds grow _________ into what will become the ________ cavity.

Answer 12

laterally
pleural

Question 13

In the ______ week, those buds join with the primitive trachea to form the _______.

Answer 13

fifth
trachea

Question 14

What happens during the pseudoglandular period?

Answer 14

The bronchi divide into secondary bronchi which forms the lobar, segmental, and intersegmental branches!

Question 15

Respiration becomes possible at what week?

Answer 15

24th week

Question 16

The terminal saccules make what possible?

Answer 16

Respiration

Question 17

From 26 weeks to birth, what period is occuring?

Answer 17

The terminal saccular

Question 18

What occurs during the terminal saccular period?

Answer 18

Continued development of the saccules and an increase of the lung’s ability to perform gas exchange

Question 19

What period overlaps the terminal saccular period?

Answer 19

Alveolar period

Question 20

When does the aleveolar period occur?

Answer 20

32 wks to birth

Question 21

What can the echogenicity of the lungs be compared to?

Answer 21

That of the spleen or liver

Question 22

Early in gestation, lung echogenicity is…

Answer 22

is equal to or slightly less than that of the liver

Question 23

Can sonography assess lung maturity?

Answer 23

No

Question 24

What is the best way to assess lung maturity?

Answer 24

Amniocentesis

Question 25

How can you rule out pulmonary agenesis?

Answer 25

Colour Doppler!

Question 26

What does imaging the diaphragm help differentiate?

Answer 26

Cystic intrathoracic masses of pulmonary origin from those that are intraabdominal origin

Question 27

Where is the thymus located?

Answer 27

Posterior to the sternum at the level of the great vessels of the heart; anterior to the aorta and pulmonary artery

Question 28

When is the thymus imaged?

Answer 28

When a large pleural effusion is present.

Question 29

Assessing the fetal thymus may be useful when determining...

Answer 29

IUGR, chorioamnionitis

Question 30

The larynx is located in the fetal neck anterior to the trachea at the level of which cervical vertebrae?

Answer 30

Third to sixth

Question 31

When filled with fluid, what structures are best seen coronally?

Answer 31

Oropharynx and laryngeal

Question 32

A persistently fluid filled trachea can indicate...

Answer 32

Laryngeal atresia or stenosis

Question 33

Pleural effusion is associated with...

Answer 33

Hydrops, congenital cardiac anomalies, orchromosomal anomalies and polydatyly

Question 34

A small trace amount of fluid in the chest is normal. True or false.

Answer 34

False. NO FLUID IN THE CHEST IS OK

Question 35

What is CCAM?

Answer 35

Congenital Cystic Adenomatoid Malformation

Question 36

The most frequently identified mass in the fetal chest is...

Answer 36

CCAM

Question 37

How many types of CCAM are there?

Answer 37

3 types!

Question 38

Describe CCAM I

Answer 38

A single cyst or multiple large cysts measuring 2-10cm in diameter with trabeculated wall or smaller cystic outpouchings

Question 39

Describe CCAM II

Answer 39

A mass made of multiple, uniform-sized cysts, 0.5-2cm in diameter

Question 40

Describe CCAM III

Answer 40

Multiple microscopic cysts measuring between 0.5 - 5.0 mm, present numerous reflecting surfaces to the US beam. Small cysts cannot be resolved individually, appear as a single, solid, homogenously echogenic mass.

Question 41

Patients with CCAM may have associated...

Answer 41

renal, cardiac, or gastrointestinal malformations (common with CCAM II)

Question 42

CCAM types I and II have a better prognosis than CCAM III - true or false?

Answer 42

True

Question 43

Which CCAM is... an echogenic mass containing small cysts?

Answer 43

CCAM II

Question 44

Which CCAM is... a unilateral pulmonary mass with one or more large cysts?

Answer 44

CCAM I

Question 45

Which CCAM is... Homogenous echogenic mass?

Answer 45

CCAM III

Question 46

The mass effect of CCAM can cause...

Answer 46

hydrops, pleural effusion, and inversion of the diaphragm

Question 47

How does Colour Doppler differentiate CCAM from Pulmonary Sequestration and Diaphragmatic Hernia?

Answer 47

CCAM has flow going into the mass from arterial supply via the pulmonary vessels

Question 48

What is pulmonary sequestration?

Answer 48

Is a solid, nonfuctioning mass of lung tissue contained within the pleural sac that lacks communication with the trachebronchial tree and has a systemic arterial blood supply.

Question 49

Pulmonary Sequestration is more common in males or females?

Answer 49

Males

Question 50

The extralobar type either above or below the diaphragm has its own...

Answer 50

Pleural sac and systemic venous drainage

Question 51

The lung mass of an intraloblar pulmonary sequestration is found where?

Answer 51

Inferior to the diaphragm

Question 52

Nuchal edema is associated with...

Answer 52

nonimmune fetal hydrops, fetal demise, and some skeletal dysplasias

Question 53

Fetal edema is typically limited to the...

Answer 53

Neck

Question 54

Fetal edema, while typically limited to the neck, can be associated with fetal hydrops and...

Answer 54

inreased thickness, forming a halo pattern around the neck, thorax, or abdomen

Question 55

Cystic hygromas is what?

Answer 55

Benign abnormalities of lymphatic origin

Question 56

What is one of the most common abnormalities to see in the first trimester?

Answer 56

Cystic hygromas

Question 57

What does cystic hygromas look like on US?

Answer 57

Lymphatic sacs dilate and appear unilocular or multiple locular cystic masses. Can also cause venous obstruction.

Question 58

What are the causes of Immune Fetal Hydrops?

Answer 58

Fetal anemia, and Rh incompatibility

Question 59

What are the causes of Nonimmune Fetal Hydrops?

Answer 59

Heart arrhythmias, intrauterine infection, chromosomal anomalies, masses causing venous obstruction, blood disorders, renal anomalies, maternal disease

Question 60

What are the sonographic findings of Nonimmune Fetal Hydrops?

Answer 60

Skin thickening, pleural and pericardial effusion, ascites, hepatomegaly, splenomegaly. Placenta thickens to greater than 4cm due to fetal anemia. Polyhydramnios is a warning sign.

Question 61

What is CDH?

Answer 61

Congenital Diaphragmatic Hernia. A defect of the diaphragm that allows the contents of the abdomen to migrate into the thorax.

Question 62

The posterolateral hernitation through the foramen of Bochdalek is found on the right or left side?

Answer 62

On the left side

Question 63

CDH happens more commonly in females or males?

Answer 63

Males

Question 64

CDH occurs more commonly on the left or right side?

Answer 64

Left

Question 65

A posterior diaphragmatic defect will allow which organs to move into the chest?

Answer 65

The stomach, bowel, or other organs

Question 66

What can simulate CDH?

Answer 66

Cystic abnormalities

Question 67

A fetus with CDH has a larger or smaller than normal AC measurement?

Answer 67

smaller

Question 68

The heart and the mediastinum shift _____ from the side of herniation.

Answer 68

away

Question 69

When does surgery need to be completed by for CDH intervention?

Answer 69

24 wks

Question 70

What organ in the abdomen during CDH shows the highest survival rate?

Answer 70

The Liver!