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OBGYN 2 > M7: Fetal Chest Pathology > Flashcards

M7: Fetal Chest Pathology Flashcards

1
Q

How does the diagram appear on US

A

Hypoechoic linear structure b/w the lungs and abdomen

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2
Q

Why is the diaphragm hypo?

A

There’s no air in the lungs, and some fluid

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3
Q

When is the diaphragm easiest to see

Is what view?

A

Later gestation

Parasagittal scans

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4
Q

Echogenicity of fetal lung tissue

Echgenicity compared to liver

A

Homogenous

Isoechoic
Hyperechoic

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5
Q

What do we assess when scanning the heart (in general)

A

4 chambers
That it occupies 1/3 of the fetal chest
Apex points to the left w/ axis at about 45 degrees

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6
Q

What must you always do when scanning the heart

A

Zoom and sector down

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7
Q

What is pulmonary hypoplasia

Can it be lethal

A

When one or both lungs are underdeveloped

Yes

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8
Q

Fetuses under how many weeks are not considered viable w/ pulmonary hypoplasia

A

24

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9
Q

Which drugs given in utereo can help w/ the exchange of 02

A

Steroids

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10
Q

Possible causes of pulmonary hypoplasia

A

Restricted chest cage w/ skeletal dysphasia
Decrease amniotic fluid
Chest masses
Pleural

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11
Q

Most common cause of pulmonary hypoplasia

A

Lack of fluid, causes by PROM and genitourinary anomalies

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12
Q

US methods to predict pulmonary hypoplasia

A
  • measure (outer to outer) the TRX chest circumference at the level of the 4CH view
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13
Q

When would you not measure outer-outer when doing a chest circumference measurement

A

If the fetus has Edema/hydrops

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14
Q

What is CCAM/CPAM

A

Congenital cystic adenomatoid malformation / congenital pulmonary airway malformation

It’s a type of hamartoma that usually effects 1 lobe of the lung and communicates w/ the tracheobronchial tree

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15
Q

3 classifications of CPAM

A

Type 1, 2, and 3

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16
Q

CPAM is associated with which conditions

A

Hydrops
Pulmonary hypoplasia
Polyhydramnious

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17
Q

If the CPAM is large what might it cause

A

Mediastinal shift

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18
Q

What is a hamartoma

A

Overgrowth of tissue

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19
Q

Describe type 1 CPAM

A

Macrocystic w/ cysts >2cm

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20
Q

Describe type 2 CPAM

A

Macro and microcystic, cysts are smaller than 1.5 cm

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21
Q

Describe type 3 CPAM

A

Microcystic, will see multiple interfaces and lungs will be echogenic

The heart will also be very displaced

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22
Q

Prognosis for CPAM

A

-Depends on mediastinal shift and hydrops

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23
Q

Can CPAM disappear on its own

A

Yes

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24
Q

Is intervention usually need for CPAM

A

No, unless hydrops in seen

But cysts may be drained or masses may be surgically resected

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25
Q

DDX for CPAM

A

Sequestration
Bronchogenic cyst
Congenital diaphragmatic hernia (CDH)

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26
Q

What is pulmonary squestation

A

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

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27
Q

Does pulmonary squestation tissue communicate w/ the bronchial tree

A

No

28
Q

Where does pulmonary squestation get its blood supply

A

An ectopic arterial supply that branches off the descending AO

Venous drainage is to the systemic system, not the pulmonary veins

29
Q

Does pulmonary squestation occur more commonly in the L or R lung

A

Left

30
Q

US appearance of pulmonary squestation

A

Uniform hyperechoic mass

Look for artery feeding off the AO

31
Q

pulmonary squestation is associated w/ which conditions

A

Hydrops and polyhydramnious, secondary to the mass effect

32
Q

Prognosis for pulmonary squestation

A

Good unless associated w/ hydrops

33
Q

Does pulmonary squestation often resolve on it own

A

Yes

34
Q

Ddx for pulmonary squestation

A

CPAM III

35
Q

What’s the mass effect w/ pulmonary squestation

A

Mass pushing on the heart and mediastinum

36
Q

How can you differentiate b/w pulmonary squestation and CPAM on US

A

pulmonary squestation will have the branch feeding off the artery

37
Q

What is a bronchogenic cyst

A

A cyst in the lung, lined w/ bronchial epithelium

38
Q

Bronchogenic cysts are associated w/ what anomalies

A

TE fistula

Lung sequestration

39
Q

US appearance of Bronchogenic cysts

A

Uni/multiocular cyst

Mediastinal shift

40
Q

DDX for Bronchogenic cysts

A

CPAM type 1

41
Q

Describe a diaphragmatic hernia

2 types

A

A defect in the diaphragm that allows the abdo contents to herniate up into the chest

  1. foramen of bochdalek
  2. foramen of maorgagni
42
Q

Which structures can herniate into the chest

A

Intestines
Stomach
Liver

43
Q

Which side do diaphragmatic hernias usually occur

A

Left

44
Q

prognosis for diaphragmatic hernia

A

good if theres no other anomalies

45
Q

describe a foramen of bochdalek hernia

A
  • posterolateral defect in the diaphragm, more commonly on the L side
  • can be a hole in the diaphragm, or it can be intact but weak
46
Q

what may you see w/ a left foramen of bochdalek hernia

A
  • stomach or intestines in chest (look for parastalsis)

- lung w/ absence of diaphragm + mediastinal shift

47
Q

what may you see w/ a right foramen of bochdalek hernia

A
  • liver in chest which is hard to tell apart from the lungs (use colour)
  • may not see mediastinal shift as much
48
Q

a mediastinal shift is always to what side

A

right

49
Q

describe a foramen of morgagni hernia

it usually involves which organ

A

-partial or complete absence of central diaphragm (think midline b/c of gag reflex)

liver

50
Q

is there a mediastinal shift w/ a foramen of morgagni hernia

A

yes, but heart is still on L side

51
Q

which type of diaphragmatic hernia is more common

A

bochdalek

52
Q

key US sign of CDH

other signs

A

mediastinal shift

cystic components in fetal chest
diaphragm not intact on SAG scan
stomach not seen in the abdo

53
Q

what is the cystic component in the fetal chest w/ CDH

is it hard to see

A

the stomach, or bowel

yes, can only see if fetus has been swallowing

54
Q

what does CDH cause

A

pulmonary hypoplasia

55
Q

is pleural fluid in the lungs always abnormal

what can happen if its a large collection

A

yes,

can cause pulmonary hypoplasia

56
Q

define hydrops

A

fluid in 2 body cavities, or fluid in 1 cavity w/ edema

57
Q

2 types of pleural effusion

describe them

A

serous:
a sign of hydrops
associated w/ down and turners
hypoechoic

chylous:
collection of lymphatic fluid (appears white)
maybe associated w/ polyhydramnios

both may displace lungs towards midline

58
Q

US appearance of pleural effusion

A
  • cystic collection above the diaphragm
  • unilateral
  • possible mediastinal shift
  • may invert diaphragm
59
Q

Tx for pleural effusion

when is this done

A

hydrothorax and chylothorax:

  • thoracentesis
  • shunt fluid into abdo or amniotic cavity
  • no treatment, may resolve on its own

treatment is done if the fetus is compromised

60
Q

describe a tracheal atresia

US appearance

A

congenitally non-patent airway

Enlarged lungs and airways
flat diaphragm
ascites w/ polyhydramnios

61
Q

is a sm amount of amniotic fluid naturally produced in the fetal lungs

A

yes

62
Q

describe an esophageal atresia

US appearance

A

congenitally absence of a segment of the esophagus

small or no stomach bubble - depends on if a TE fistula is present
cystic strucutre in neck that disappears
polyhydramnios
fetal vomiting

63
Q

esophageal atresia is associted w/ which conditions

A

TE fistula
down syndrome
VACTERL
heart defects

64
Q

list some chest wall shape abnormalities

what can they cause

A

narrow
long
bell shaped
dwarfism

pulmonary hypoplasia

65
Q

describe ectopia cordis

A

an anterior chest wall fusion defect that causes the heart will be outside the chest cavity

66
Q

describe the pentalogy of centrell

A

5 defects involved: SOAPE

sternum
anterior diaphragm
pericardium
ectopia cordis w/ heart defects
omphalocele

OBGYN 2 (15 decks)

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