Fetal Chest Pathology/GI Flashcards
How much of the chest cavity does the heart take up and which way should the apex point?
1/3, points to the left
When one or both lungs are underdeveloped
Pulmonary hypoplasia
Why are fetuses <24 weeks not considered viable?
Pulmonary immaturity
Most common cause of pulmonary hypoplasia
Lack of amniotic fluid
High GI obstruction/swallowing deficits causes?
Polyhydramnios
Any bilateral GU obstruction/renal agenesis causes what?
Oligohydramnios
At what level is a chest circumference measured? What is proper caliper placement?
4 chamber heart in transverse, measured outer to outer
What is CPAM
Congenital pulmonary airway malformation
Briefly describe CPAM type 1
Macrocystic >2cm
Describe CPAM type 2
Macro & microcystic, <1.5cm
Describe CPAM type 3
Microcystic, appears as very echogenic on U/S
Ectopic pulmonary tissue covered by its own pleura (little lung beside the left lung)
Pulmonary sequestration
Has an ectopic arterial supply off descending AO
Pulmonary sequestration
A cyst in the lung lined with bronchial epithelium
Bronchogenic cyst
A defect in the diaphragm which allows the abdominal contents to herniate into the chest
Diaphragmatic hernia
Two types of diaphragmatic hernias
- Foramen bochdalek: posterior lateral defect
2. Foramen maorgagni: central defect
What is the key sonographic sign of CDH? (Diaphragm hernia)
mediastinal shift
Lack of muscle in the diaphragm where abdominal contents push into chest area
Eventration of the diaphragm
Any amount of pleural fluid is abnormal at any gestation
Pleural effusions, may cause pulmonary hypoplasia
2 types of pleural effusion
- Serous
2. Chylous- lymphatic fluid
Congenitally non patent airway
Tracheal atresia
Congenitally non patent esophagus
Esophageal atresia
Anterior chest wall fusion defect that may cause the heart to be outside the cavity
Ectopia cordis
5 defects involved: sternum, anterior diaphragm, pericardium, ectopia cordis, omphalocele
Pentalogy of Cantrell
Bronchopulmonary sequestration is difficult to differentiate from which CPAM?
CPAM 3
Which congenital lung lesion is a hamartoma?
CPAM
A mediastinal shift with dextrocardia is detected on a fetus. What other finding would support congenital diaphragmatic hernia?
Absent fetal stomach
With tracheal atresia, the lungs will appear?
Enlarged with distended airways
An absent stomach on a fetal AC is concerning for what?
Diaphragmatic hernia and esophageal atresia
At 8 weeks, the gut herniates outside the fetal abdominal cavity, is this normal?
Yes, it will return to the abdomen by 12 weeks
Defect at the base of the cord where the abdominal contents herniate into the umbilical cord.
Omphalocele
What lab value is increased with an omphalocele?
MSAFP
A small omphalocele containing bowel only has a higher association of what?
Chromosomal abnormality
What 4 things need to be assessed when there is an omphalocele?
- Is there a membrane surrounding the contents?
- Is the cord at the center of the mass?
- What organs are present in the omphalocele?
- Is there ascites?
A defect in abdominal wall to the right of the umbilical cord insertion
Gastroschisis
Bowel freely floating in the amniotic fluid with no covering membrane
Gastroschisis
Missing limbs or club feet, abdominal content may be outside the body cavity, short or absent cord
Body stock anomaly
Absent bladder with a soft tissue anterior mass
Bladder exstrophy
The rectum and urogenital sinus develop from what primitive structure?
The cloaca
“Double bubble” appearance
Duodenal atresia
What is duodenal atresia usually associated with?
Trisomy 21
Obstruction of small bowel with meconium
Meconium ileus
T/F on ultrasound, bowel should be more echogenic than bone
False. It should be the same echogenicity as bone
Inflammation of the peritoneum that appears as echogenic reflectors throughout the bowel
Meconium peritonitis
Dilation of the umbilical vein after it enters the fetal abdomen
Umbilical vein varix
Echogenic or hyperechoic focus +/- shadowing in the fetal liver
Hepatic calcification
