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DMST 315 OBGYN 3 > Fetal Chest Normal And Pathology > Flashcards

Fetal Chest Normal And Pathology Flashcards

1
Q

What is the diaphragm?

A

Hypoechoic linear structure between lungs and abdomen

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2
Q

When is it easier to see the diaphragm?

A

Later gestations

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3
Q

How is diaphragm usually visualized?

A

On Parasagittal scans

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4
Q

What does the fetal lungs look like on U/S?

In terms of echotexture

A

Homogenous

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5
Q

Fetal lungs are usually compared to what for echogenicity? What do we look for?

A
  1. Liver
  2. Isoechoic and hyperechoic
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6
Q

What are requiremets of fetal lung needed for development? 3

A
  1. Adequate space for growth
  2. Fetal breathing movements
  3. Fluid within lungs to distend developing airways Adequate amniotic fluid volume
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7
Q

How much of the fetal chest does the fetal heart take up?

A

1/3

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8
Q

Where is the fetal heart located in relation of the fetal body?

A

Left of mediastinum and sits in the space in the chest between the lungs that contains the heart and other important structures

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9
Q

How does the apex of the heart tilt/ point?

A

Apex points to the left with axis about 45 degrees

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10
Q

What are some examples of lung pathology?9

A
  1. Pulmonary hypoplasia
  2. Congenital cystic adenmatoid malformation
  3. Congenital pulmonary airway malformation
  4. Pulmonary sequestration
  5. Bronchogenic cyst
  6. Diaphragmatic hernia
  7. Pleural effusion
  8. Esophageal atresia
  9. Tracheal atresia
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11
Q

What is pulmonary hypoplasia?

A

When one or both lungs are underdeveloped

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12
Q

In terms of pulmonary hypoplasia, fetus under which range are not considered viable due to pulmonary immaturity ? (weeks)

A

<24

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13
Q

At term pulmonary hypoplasia is caused by what?4

A
  1. Restricted chest circumference/ rib cage (some restricted chest restriction)
  2. Chest masses
  3. Pleural effusion
  4. Decreased amniotic fluid (oligiohydramnios)
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14
Q

Most frequent cause of pulmonary hypoplasia is what?2

A

Lack of amniotic fluid caused by
1. PROM - premature rupture of membranes
2. GU anomalies (genitourinary)

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15
Q

Amniotic fluid is produced by membranes until when?

A

Fetal kidneys begin to produce urine

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16
Q

What is the pathway of amniotic fluid for baby?5

A
  1. Fetus swallows amniotic fluid
  2. Fluid goes through GI tract
  3. Absorbed by the GI tract
  4. Exerted by kidneys as urine
  5. Fetus urinates back into the amniotic cavity
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17
Q

Amniotic fluid is produced in a small amount by what?4

A
  1. Fetal lungs
  2. Fetal skin
  3. Nose
  4. Mouth
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18
Q

Any high GI obstruction/ swallowing deficits causes what?

A

Polyhydraminos

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19
Q

Any bilateral GU obstruction/ renal agenesis, causes what?

A

Oligiohydramnios

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20
Q

What is the method to predict pulmonary hypoplasia sonograpically?2

A
  1. Transverse chest circumference at level of 4CH heart view
  2. Measure outer to outer (except in cases of skin edema/ hydrops)
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21
Q

Congenital cystic adenomtoid malformation is now called what?

A
  1. CPAM
  2. Congenital pulmonary airway malformation
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22
Q

What is the three classifications of CPAM?

A
  1. Type 1
  2. Type 2
  3. Type 3
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23
Q

CPAM is a type of what disorder? Which lobe is affected?2

A
  1. Hamartoma
  2. Usually 1 lobe affected (95% unilateral)
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24
Q

CPAM malformation communicates with what?

A

Tracheobronchial tree

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25
Q

Large CPAM can result in what?

A

Mediastinal shift

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26
Q

What happens with the mediastinal shift with a large CPAM?

A

Heart position deviates, compressing lungs and great vessels

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27
Q

CPAM is associated with what? 3

A
  1. Hydrops
  2. Pulmonary hypoplasia
  3. Polyhydraminos
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28
Q

What does CPAM type 1 look like? 4 ( size, appearance, amount, contents)

A
  1. Macrocystic
  2. Single or multiple
  3. Will appear as large, anechoic cystic spaces
  4. > 2cm
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29
Q

What does CPAM 2look like?3 (contents, size, echogenicity)

A
  1. Macro and micro cystic
  2. Mixed echogenicity
  3. Cysts 0.5 - 2 cm
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30
Q

What is CPAM type 3?

A
  1. Microsystems
  2. Multiple microscopic cysts (0.5-5mm)
  3. Appears as homogenous hyperechoic masses
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31
Q

What is the prognosis of CPAM?

A

Depends on mediastinal shift and whether hydrops occurs

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32
Q

Would CPAM have the chance to regress?

A

Yes it may even disappear on its own

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33
Q

Is any intervention needed for CPAM?

A

No intervention is performed unless hydrops is noted

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34
Q

What is the way we drain CPAM cysts?

A

Antenatally or surgically reset the mass postnatally

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35
Q

What is the DDX of CPAM? 3

A
  1. Pulmonary sequestration
  2. Bronchogenic cyst
  3. CDH (Congenital diaphragmatic hernia)
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36
Q

What is pulmonary sequestration?

A

A mass of ectopic pulmonary tissue, covered by its own pleura

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37
Q

What is communication like for pulmonary sequestration?

A

There is no communication

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38
Q

In terms of pulmonary sequestration, what is the arterial supply like?

A

Ectopic arterial supply

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39
Q

What is the flow of blood in the venous system for pulmonary sequestration? Where is it generally based?

A
  1. Venous to systemic system not pulmonary veins
  2. 80% in left lung base
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40
Q

What is the sonographic appearance of pulmonary sequestration? What is it assocaited with? 2

A
  1. Uniform hyperechoic mass
  2. Associated with hydrops and polyhydraminos secondary to mass effect
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41
Q

When doing a sonographic investigation for pulmonary sequestration, what should we look for?

A

Feeding artery, off the aorta

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42
Q

What is the prognosis for pulmonary sequestration?

A

Good unless associated with hydrops, usually resolve on their own

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43
Q

What is a Bronchogenic cyst?

A

A cyst in the lung, lined with bronchial epithelium

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44
Q

Bronchogenic cyst results from what?

A

An abnormal budding of the foregut

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45
Q

What is Bronchogenic cysts associated with? 3

A

Forgot anomalies such as
1. TE fistulas
2. Esophageal duplications
3. Lung sequestration

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46
Q

What is the sonographic appearance of bronchitis cysts? 2

A
  1. Uni/multiocular cysts
  2. Mediastinal shift
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47
Q

What is a diaphragmatic hernia?

A

A defect in the diaphragm which allows abdominal contents to herniate up to the chest

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48
Q

What are some organs affected by diaphragmatic hernias? 3

A
  1. Intestines
  2. Stomachs
  3. Liver
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49
Q

What are two types of diaphragmatic hernias?

A
  1. Foramen of Bochdalek
  2. Foramen of Morgagni
50
Q

What is the DDX for pulmonary sequestration?

51
Q

What is a foramen of bochdalek?

A

Posterior lateral defect, more common on left than right

52
Q

What might we see with a left sided foramen of bochdalek? 2

A
  1. May see stomach or intestine in chest
  2. Lung with absence of diaphragm + Mediastinal shift
53
Q

What does a right sided foramen of Bochdalek look like? (comparison to liver, mediastinal shift) 3

A
  1. May see liver in chest
  2. Difficult to recognize liver from lung
  3. May not appreciate mediastinal shift as much
54
Q

What kind of defect is a foramen of morgagni? What might we see with it? (diaphragm) 2

A
  1. Retrosternal defect
  2. Partial or complete absence of the central diaphragm
55
Q

In terms of a foramen or morgagni, what do we normally see?

A
  1. Liver herniated into chest
  2. Mediastinal shift to extreme left (even though heart is still on left side the axis will be shifted)
56
Q

What is the sonographic appearance of CDH? (congenital diaphragmatic hernia) 4 (main key sonographic sign is msot important)

A
  1. Mediastinal shift (Key sonographic sign)
  2. Cystic component in the fetal chest
  3. Diaphragm not intact on sagittal scans
  4. Stomach not seen in abdomen or stomach alignment is abnormal
57
Q

How difficult are some cystic components in the fetal chest seen with CDH? When would we see them?

A
  1. Difficult to catch
  2. Only if fetus has recently been swallowing
58
Q

What does CDH cause? (to the lungs)

A

Pulmonary hypoplasia

59
Q

What is CDH associated with? 3

A
  1. Increase in accompanying abnormalities
  2. Chromosomal abnormalities including T18 and 21
  3. Anencephaly most frequently then Hydrocephalus, encephaloceles, spina bifida
60
Q

Majority of CDH defects original where?

A

CNS origin

61
Q

What is eventration of diaphragm?

A
  1. Diaphragm lacks muscle, therefore the abdominal contents push into chest area
62
Q

Eventration of diaphragm may cause what? (to the lungs)

A

Pulmonary hypoplasia

63
Q

What is another name for pleural effusion?

A

Hydrohorax

64
Q

What is a pleural effusion?

A

Any amount of pleural fluid in abnormal at any gestation

65
Q

If there is a large amount of pleural effusion, what might happen?

A

Pulmonary hypoplasia

66
Q

What are two types of pleural effusions?

A
  1. Primary
  2. Secondary
67
Q

What is seen with primary pleural effusions?

A
  1. Chylous- lymphatic fluid
  2. May be associated with polyhydraminos
68
Q

What are things we see with secondary pleural effusions?

A
  1. Serous filled
  2. Signs of Hydrops
69
Q

Secondary pleural effusions are usually associated with what disorder?

A

Downs and Turner’s syndrome

70
Q

Pleural effusions are unilateral or bilateral?

A

Can be both

71
Q

What is the sonographic appearance of pleural effusions? 3

A
  1. Cystic collection above the diaphragm
  2. In unilateral - may cause mediastinal shift
  3. If large - may invert the diaphragm and cause pulmonary hypoplasia
72
Q

What is the treatment of pleural effusions? 3

A
  1. Thoracentesis
  2. Shunt fluid into the abdomen or amniotic cavity
  3. May resolve on its own
73
Q

What are three examples of things that would shift the heart to the right?

A

Mass effects
1. Pleural effusion
2. Diaphragmatic hernia
3. CPAM

74
Q

What is tracheal atresia?

A

Congenitally non patent airway

75
Q

How common are tracheal atresia?

A

Rare, but is fatal post- nasally if not recognized

76
Q

What is the sonographic appearance of tracheal atresia? 5

A
  1. Bilaterally enlarged lungs with distended airways
  2. May see fluid-filled trachea and main bronchi
  3. Flat or inverted diaphragms
  4. Heart shifted anteriorly
  5. Ascites and polyhydramnios
77
Q

In terms of tracheal atresia, a small amount of amniotic fluid is produced by what?

A

Fetal lung

78
Q

With Tracheal atresia, fetal lungs will appear how?

A

Hyperechoic as this fluid cannot get out of the lungs. Because of increased fluid in the lung tissue the echogenicity is enhanced in the tissue

79
Q

What is esophageal atresia?

A

Congenital absence of the continuation of the esophagus

80
Q

Esophageal atresia is often associated with what?

81
Q

What is the sonographic appearance of esophageal atresia?

A
  1. No stomach bubble
  2. Cystic structure in neck (disappears)
82
Q

What is esophageal atresia associated with? (disorders) 2

A

Down syndrome and VACTERL

83
Q

What is the chest wall shape abnormalities? 3

A
  1. Narrow
  2. Long
  3. Bell shaped (dwarfism, skeletal dysplasia)
84
Q

Chest wall shape abnormalities may cause what? (to the lungs)

A

Pulmonary hypoplasia

85
Q

What is ectopia cordis? What is seen with it? How obvious it it?

A

Chest wall abnormalities which has
1. Anterior chest all fusion defect
2. Heart is outside chest cavity
3. Obvious on real time scanning

86
Q

What is pentalogy of Cantrell?

A

Syndrome involve 5 defects

87
Q

What is the 5 defects of pentalogy of Cantrell?

A
  1. Sternum
  2. Anterior diaphragm
  3. Pericardium
  4. Ectopia cordis (likely with other heart defects)
  5. Omphalocele
88
Q

In terms of pentalogy of Cantrell, what two things are indicative of this anomaly?

A

Ectopia cordis and Omphalocele

89
Q

What does this image represent?

90
Q

What does this image represent?

A

Fetal diaphragm

91
Q

What does this image represent?

A

Fetal heart diaphragm and stomach

92
Q

What does this image represent?

93
Q

What does this image represent?

94
Q

What does this image represent?

A

Chest with 4 chamber view

95
Q

What does this image represent?

96
Q

What does this image represent?

A

CPAM type 1

97
Q

What does this image represent?

98
Q

What does this image represent?

99
Q

What does this image represent?

100
Q

What does this image represent?

A

CPAM type II

101
Q

What does this image represent?

102
Q

What does this image represent?

103
Q

What does this image represent?

104
Q

What does this image represent?

A

Pulmonary sequestration

105
Q

What does this image represent?

A

Pulmonary sequestration

106
Q

What does this image represent?

A

Bronchogenic cyst

107
Q

What does this image represent?

A

Bronchogenic cyst

108
Q

What does this image represent?

A

Bronchogenic cyst

109
Q

What does this image represent?

A

Bronchogenic cysts

110
Q

What does this image represent?

A

Foramen of Bochdalek

111
Q

What does this image represent?

A

Congenital diaphragmatic hernia

112
Q

What does this image represent?

A

Foramen of morgagni CDH

113
Q

What does this image represent?

A

Pleural effusion/ edema

114
Q

What does this image represent?

A

Pleural effusions and fetal edema

115
Q

What does this image represent?

A

Pleural effusions

116
Q

What does this image represent?

A

Tracheal Atresia

117
Q

What does this image represent?

A

Tracheal atresia

118
Q

What does this image represent?

119
Q

What does this image represent?

A

Ectopia cordis

120
Q

What does this image represent?

A

Ectopic cordis with amniotic band

DMST 315 OBGYN 3 (21 decks)

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