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OB/GYN 303 > Module 7: Fetal Chest Pathology > Flashcards

Module 7: Fetal Chest Pathology Flashcards

1
Q

How does the diaphragm appear in a fetus?

A

Hypoechoic because everything else is hyperechoic, easier to see in later gestations

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2
Q

What scan is the diaphragm seen best in?

A

Parasagittal (midline sagittal).

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3
Q

How do the fetal lungs appear?

A

Homogenous and isoechoic or hyperechoic to the liver.

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4
Q

How much of the chest does the fetal heart occupy?

A

1/3

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5
Q

What is levocardia?

A

The apex of the heart points to the left with a 45 degree axis

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6
Q

What is pulmonary hypoplasia?

A

When one of both lungs are underdeveloped (can be lethal).

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7
Q

Why are fetuses born under 24 weeks not considered viable?

A

Due to pulmonary immaturity

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8
Q

What are causes of pulmonary hypoplasia at term? (4)

A
  1. Restricted chest cage (due to some skeletal dysplasia’s)
  2. Decreased amniotic fluid
  3. Chest masses
  4. Pleural effusion
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9
Q

What is the most frequent cause of pulmonary hypoplasia?

A

The lack of fluid caused by PROM or GU abnormalities.

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10
Q

What is PROM?

A

Premature rupture of membranes

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11
Q

What are GU anomalies?

A

Genitourinary

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12
Q

What is amniotic fluid produced by?

A

Membranes until the fetal kidneys begin to produce urine from the swallowed fluid.

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13
Q

What causes polyhydramnios?

A

Any high GI obstruction/swallowing deficits will cause more fluid outside by preventing the fetus from swallowing the fluid.

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14
Q

What causes oligohydramnios?

A

Bilateral GU obstruction/renal agenesis

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15
Q

How can we predict pulmonary hypoplasia sonographically?

A

Thoracic circumferance

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16
Q

How is thoracic circumference measured?

A

Outer to outer at the level of the 4 chamber heart view in trans.

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17
Q

When is the thoracic circumference NOT measured outer to outer?

A

In cases of skin edema/hydrops

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18
Q

What is CCAM and what is it now called?

A

Congenital Cystic Adenomatoid Malformation

Now called:

CPAM: Congenital Pulmonary Airway Malformation

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19
Q

How many classifications of CCAM/CPAM are there?

A

Three types (I, II, III)

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20
Q

What is CCAM/CPAM?

A

A non-cancerous mass of abnormal lung tissue, usually located in one part (lobe) of a lung.

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21
Q

What does CCAM/CPAM communicate with?

A

Tracheobronchial tree

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22
Q

What may happen with a large CCAM/CPAM?

A

A Mediastinal shift

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23
Q

What is CCAM/CPAM associated with? (3)

A
  • Hydrops
  • Pulmonary hypoplasia
  • Polyhydramnios
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24
Q

What is type one CCAM?

A

Macrosystic >2cm

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25
Q

What is type two CCAM?

A

Macro and microcystic smaller than 1.5 cm

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26
Q

What is type 3 CCAM?

A

Microcystic and sonographically very hyperechoic

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27
Q

What is the prognosis of CCAM/CPAM?

A

Depends on the mediastinal shift and hydrops but it may regress on its own or intervention may be necessary if hydrops is noted.

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28
Q

What is the treatment of CCAM/CPAM?

A

MAy drain cyst or surgically resect the mass

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29
Q

What is the DDx of CCAM/CPAM? (3)

A
  • Pulmonary Sequestration
  • Bronchogenic cyst
  • Congenital Diaphragmatic Hernia (CDH)
30
Q

What is pulmonary sequestration?

A

A mass of ectopic pulmonary tissue covered by it’s own pleura that does not communicate with the bronchial tree or pulmonary veins.

31
Q

What supplies a pulmonary sequestration?

A

An ectopic arterial supply off of the descending aorta.

32
Q

Where is 80% of pulmonary Sequestration located?

A

Left lung base

33
Q

What is the US appearance of Pulmonary Sequestration?

A

A uniform hypoechoic mass with a feeding artery.

34
Q

What is Pulmonary Sequestration associated with?

A

Hydrops and polyhyramnios

35
Q

What is the prognosis of Pulmonary Sequestration?

A

Good, often resolves on its own unless associated with hydrops.

36
Q

What is the DDX of Pulmonary Sequestration and how can you differentiate the two on US?

A

CCAM III

Use doppler to find a feeding artery off of aorta to support Pulmonary Sequestration diagnosis.

37
Q

What is a cyst in the lung lined with bronchial epithelium called?

A

Bronchogenic cyst

38
Q

What are bronchogenic cysts associated with?

A

Foregut anomalies (TE fistula, lung sequestration)

39
Q

What is the US appearance of a bronchogenic cyst?

A

Uni/multilocular cyst in the lung causing a mediastinal shift.

40
Q

What is a diaphragmatic hernia?

A

A defect in the diaphragm that allows abd contents to herniate up into the chest (intestines, stomach, liver).

41
Q

What are the major types of diaphragmatic hernias?

A
  1. Foramen of Bochdalek

2. Foramen of Maorgagni

42
Q

What is foramen of Bochdalek?

A

A posterior lateral defect of the diaphragm that allows herniation of abdomen contents into the chest.

43
Q

What side is the foramen of Bochdalek on?

A

Either side but more commonly on the left.

44
Q

What are the characteristics of a left hernia through foramen of Bochdalek?

A
  • May see stomach/intestine in chest
  • Lung with absence of diaphragm
  • Mediastinal shift
45
Q

What are the characteristics of a right hernia through foramen of Bochdalek?

A
  • May see liver in chest
  • Difficult to recognize liver from lung
  • Less of a mediastinal shift
46
Q

What is the foramen of morgani?

A

A complete or partial absence of the central diaphragm allowing herniation of the abdominal organs into the chest.

47
Q

What are the characteristics of a herniation through the foramen of Morgagni? (2)

A
  • Liver in chest (may see portal flow in chest)

- Mediastinal shift where heart is still on left side but the axis is shifted

48
Q

What is the key sonographic sign of a congenital diaphragmatic Hernia?

A

Mediastinal shift

49
Q

What are the US appearances of congenital diaphragmatic hernia? (4)

A
  1. Mediastinal shift
  2. Cystic component in fetal chest
  3. Diaphragm not intact on sagittal scans
  4. Stomach not seen in abdomen
50
Q

What condition does congenital diaphragmatic hernia cause?

A

Pulmonary hypoplasia

51
Q

What is it called when the diaphragm lacks muscle and therefore the abdominal contents push into the chest area?

A

Eventration of the diaphragm

52
Q

What may Eventration of the diaphragm cause?

A

Pulmonary hypoplasia

53
Q

What is a pleural effusion and is it abnormal in a fetus?

A

Fluid surrounding the lungs is abnormal at any gestation.

54
Q

What can a large pleural effusion cause?

A

Pulmonary hypoplasia

55
Q

What are the two types of pleural effusions?

A
  1. Serous

2. Chylous (lymphatic fluid)

56
Q

What is serous pleural effusions a sign of?

A

Hydrops

57
Q

What are serous and chylous pleural effusions associated with?

A

Serous = Downs, Turner’s

Chylous = Polyhydramnios

58
Q

How do pleural effusions appear on US?

A
  • Sonolucent fluid collections above diaphragm
  • Unilateral may cause mediastinal shift
  • May invert the diaphragms
59
Q

What are other names for serous and chylous pleural effusions?

A

Hydrothorax and chylothorax

60
Q

What is the treatment for hydrothorax and chylothorax?

A
  1. Thoracentesis
  2. Shunt to abdomen or amniotic fluid
  3. None (may resolve on its own)
61
Q

What is tracheal atresia?

A

A congenitally non-patent airway

62
Q

What is the US appearance of tracheal atresia?

A
  • Bilaterally enlarged lungs with distended airways
  • Flat diaphrams
  • Ascites and polyhydamnios
63
Q

Why is ascites and distended airways a sign of tracheal atresia?

A

Because a small amount of amniotic fluid is produced in the lungs and atresia prevents it from getting out.

64
Q

What is esophageal atresia?

A

A congenitally non-patent esophagus

65
Q

What is esophageal atresia associated with?

A
  1. TE fistula
  2. Down Syndrome
  3. VACTERL
66
Q

What abnormalities can occur with the chest wall shape?

A
  • Narrow
  • Long
  • Bell-shaped
  • Dwarfism (from skeletal dysplasia)
67
Q

What an an abnormal chest shape cause?

A

Pulmonary hypoplasia

68
Q

What is the term for when the heart is outside the chest cavity?

A

Ectopia cordis

69
Q

What is ectopia cordis due to?

A

An anterior chest wall fusion defect

70
Q

What is Pentalogy of cantrell? (5)

A

A rare syndrome causing defects of the:

  1. Sternum
  2. Anterior diaphragm
  3. Pericardium
  4. Ectopia cordis with heart defects
  5. Omphalocele

OB/GYN 303 (21 decks)

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