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A DDx > OBS DDx > Flashcards

OBS DDx Flashcards

1
Q

Causes of asymmetric IUGR:

A

Placental insufficiency
High BP / PET
Ehler Danlos
Severe malnutrition

Usually only seen in 3rd trimester

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2
Q

Causes of symmetric IUGR:

A

TORCH infection
Fetal Alcohol syndrome
Drug abuse
Chromosomal abnormalities

Usually seen throughout pregnancy

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3
Q

Bilobed placenta:

A

Two near equal size lobes connected by thin strip.

Risks:

  • vasa previa
  • Post partum haemorrhage
  • Velamentous insertion
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4
Q

Succenturiate lobe:

A

One or more small accessory lobes.

Risks:

  • vasa previa
  • post partum haemorrhage
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5
Q

Circumvallate placenta:

A

Rolled placenta edges with smaller chorionic plate

Risks:

  • placental abruption
  • IUGR
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6
Q

Thin placenta:

A 
< 1cm thick
Causes:
 - Placental insufficiency
 - Maternal HTN
 - Maternal DM
 - T 13
 - T 18
 - PET
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7
Q

Thick placenta:

A 
> 4cm thick
Causes:
 - Hydrops
 - Maternal DM
 - Severe maternal anaemia
 - Infection
 - Abruption
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8
Q

Placenta abruption

A

Painful bleeding

Pre mature seperation of placenta from myometrium / retroplacental complex.

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9
Q

Placenta previa:

A

Painless bleeding 3rd trimester.
Low implantation of placenta:
- Low lying: making within 2cm of internal os
- Marginal: extends to edge of internal os but doesn’t cover
- Complete: covers internal os
- Central: centered over internal os.

normal > 3cm from os.

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10
Q

Placenta accreta:

A

Villi attach to myometrium, without invading

“A: Attach”

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11
Q

Placenta Increta:

A

Villi partially invade the myometrium

“I: Invade”

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12
Q

Placenta Percreta:

A

Villi penetrate through myometrium or beyond into adjacent organs; bowel / bladder.
“P: Penetrate”

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13
Q

Velamentous cord insertion:

A

Cord inserts into fetal membranes outside placental margin.
More common in twins
Increased risk of IUGR

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14
Q

Vasa Previa:

A

Fetal vessels cross or almost cross the internal cervical os.
Type 1: fetal vessels connect to velamentous cord insertion within the main placental body
Type 2: fetal vessels connect to bilobed placenta or succenturiate lobe.

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15
Q

Doppler values:

A

Normal values at any 28 - 40 weeks scan:

AFI: 10 - 20
UA PI: < 1.1
MCA PI: > 1.7
CPR: > 1.7

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16
Q

Abnormal doppler order:

A

Before 34 weeks:

  • Abnormal dopplers occur in order
  • Increased UAPI, followed by reduced MCA PI and CPR followed by increased DV PI.

After 34 weeks:

  • abnormal dopplers not in order.
  • Low MCA PI or CPR can be isolated, and associated with increased risk of lactic acidosis
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17
Q

Trisomy 21 Features:

A

Absent Nasal Bone
Increased nuchal fold (2nd trimester weeks 15 - 21, >6mm)
Increased nuchal translucency (1st trimester, abnormal > 3mm)
Microcephaly
Cystic hygroma

Congenital heart disease: AVSD, VSD
Echogenic heart focus.

Duodenal atresia
Gastric atresia
Echogenic bowel
Renal dilation

Short femur / humerus
Hypoplasia middle phalanx little finger / Clinodactyly.
Sandal gap

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18
Q

Trisomy 18 Features:

A 
Strawberry skull
Choroid plexus cysts
Facial cleft
Micronathia
Absent NB
Increased nuchal fold
Dandy Walker malformation

Cardiac anomalies: VSD

Diaphragmatic hernia
Omphalocele
Horse shoe kidney, hydroneprhosis.

Club foot, rocker bottom foot.
Clenched hand / over lapping fingers.

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19
Q

Trisomy 13 Features:

A 
Absent Nasal bone
Increased nuchal fold
Cleft lip / palate
Holoprosenchepaly
Encephalocele

Congenital heart disease.

Omphalocele.
Diaphragmatic hernia
Horse shoe kidney, Polycystic kidney

Polydactyly

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20
Q

Beckwith Widermann Sydrome:

A

Syndrome of over growth
increased risk of child hood cancers, mostly sporadic, 15% AD inheritance.

Wilms tumour risk (most common)
Hepatoblastoma risk
Heme-Hypertrophy / organomegaly
Macroglossia
Omphalocele
Perinatal hypoglycaemia.
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21
Q

Meckel Gruber:

A

AR multi organ syndrome
Encephalocele
Renal dysplasia with multiple tiny renal cysts, appear as echogenic kidneys, analogous to ARPKD.
Polydactyly.

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22
Q

Fetal Hydrops:

A

2 or more: ascites, pleural effusion, pericardial effusion, skin oedema, polhydramnios, placental enlargement.

Immune:

  • Fetal haemolytic anaemia: Rh incompatibility.
  • Assess MCA VMax. > 65 is elevated.

Non immune:

  • Cardiac: structural, arrhythmias
  • Extra cardiac shunt: vein of Gale malformation, hepatic haemangioendothelioma, twin twin transfusion.
  • Infection: parvovirus, TORCH
  • Hepatitis, nephrotic syndrome
  • Venous obstruction: turners
  • Chromosomal: Turners, T21.
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23
Q

Echogenic Bowel:

A

Normally bowel iso to liver.
If equal to iliac crests = echogenic bowel.

Normal variant
T21
Infection: CMV, parvovirus, toxoplasmosis
CF
Meconium peritonitis can mimic echogenic bowel
Fetal growth restriction
Ingested blood.
Bowel atresia
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24
Q

Dilated Bowel:

A 
Normal 3rd trimester bowel
Duodenal atresia: double bubble
jejunal / ill atresia: triple bubble, sausage bowel loops
Meconium ileus - CF
Anal atresia: VACTERAL
Volvulus
25
Q

Small absent stomach:

A

Normal transient finding

Oesophageal atresia:

  • trachea-oesophageal fistula / VACTERAL
  • Late polyhydramnios
  • T18 > T21

Congenital diaphragmatic hernia

Severe oligohydramnios

Severe cleft lip.

26
Q

Abdominal Ca++ Ddx:

A

Meconium peritonitis: intra peritoneal Ca++ and ascites.
Gall stones
Hepatic Ca++
- Intrahepatic - infection, chromosomal anomalies
- Capsular - meconium peritonitis
Intra luminal Ca++:
- anala atresia +/- urinary tract anomaly VACTERAL.
Teratoma

27
Q

Increased Nuchal Translucency:

A

11 - 14 weeks
Normal: < 2.2 - 2.8mm (Age and CRL dependent)
< 2mm: risk <1%

28
Q

Echogenic kidney Ddx:

A

ARPCKD:
- eventual renal enlargement bilaterally.

Obstructive cystic dysplasia:
- Urinary tract dilation

Trisomy 13:

  • Echogenic and enlarged
  • Holoprosenchephaly, cyclopean, cleft lip
  • Cardiac defect, IUGR, polydactyly.

Meckel-Gruber:

  • renal cystic dysplasia - enlarged
  • Encephalocele
  • Post axial poly dactyly (ulnar margin)

Beckwith Widerman Syndrome:

  • Enlarged kidney, normal morphology and echo texture.
  • Macrosomia, macroglosia, omphalocele.
29
Q

Oligohydramnios:

A

AFI < 5cm / < 7cm cm in australia

Can cause Potter sequence - facial dysmorphism, pulmonary hypoplasia, club feet, MSK contractures.

Associated with IUGR with / without structure abnormality.

GU malformations:

  • Renal agenesis
  • Bladder outlet obstruction: posterior urethral valves.
  • Ureteropelvic junction obstruction
  • Renal dysplasia: ARPCKD: enlarged echogenic kidneys.
30
Q

Hydronephrosis, fetal bladder not seen:

A 
Cause of oligohydramnios likely renal anomaly.
Hydronephrosis:
- Less than 4mm always normal, 
 - greater than 10mm always abnormal
  > 6mm 16 - 20/40
  > 8mm 20 - 30/40
  > 10mm after > 30/40

Ddx:

  • Bilateral multi cystic dysplastic kidneys
  • Bilateral renal genesis
  • ARPCKD.
31
Q

Hydronephrosis, hydroureter, normal bladder:

A 
Distal ureteral obstruction / reflux is cause:
Hydronephrosis:
 - Less than 4mm always normal, 
 - greater than 10mm always abnormal
  > 6mm 16 - 20/40
  > 8mm 20 - 30/40
  > 10mm after > 30/40

Distal ureteral obstruction of ectopic insertion of upper pole moiety which inserts infers-medially, in duplication.

Ureterocele: dilation of intra mural portion of ureter.

Vesico-ureteric reflux.

Pelvi-Ureteric junction obstruction: (no hydroureter)

  • 10% bilateral
  • 25% contralateral anomaly
  • 10% extra renal anomaly.
32
Q

Hydronephrosis, hydroureter, dilated bladder:

A 
Bladder outlet obstruction:
Hydronephrosis:
 - Less than 4mm always normal, 
 - greater than 10mm always abnormal
  > 6mm 16 - 20/40
  > 8mm 20 - 30/40
  > 10mm after > 30/40

Posterior urethral valves.

  • Key hole bladder
  • Pulmonary hypoplasia, VACTERAL.

Urethral atresia

Prune Belly syndrome.

  • gross pelvi-calyceal and ureteric dilatation with renal dysplasia.
  • anterior abdominal wall underdevelopment
  • bilateral undescended testes (cryptorchidism) in males
33
Q

Polyhydramnios:

A

AFI > 25cm (increased fluid > 20cm - Australia go on 95th centime value for gestation).

Commonly idiopathic with normal fetus

Chromosomal anomalies:
- Turners, T 21, T18.

DM

Structural defects:
 - Upper GI: 
         Laryngeal, 
         Oesophageal (VACTERAL), 
         Duodenal atresia (T21).
 - Secondary obstruction: 
        diaphragmatic hernia, 
        gastroschisis, 
        omphalocele, 
        CPAM.
 - Severe CNS anomaly 
        Anencephaly.
 - Twin twin transfusion (largest pocket > 8cm)
 - Placental abnormality: choriocarcinoma.

Hydrops

34
Q

Omphalocele:

A

Midline anterior abdominal wall defect, covered by peritoneum.
Umbilical cord inserts centrally at base of herniated sac.
Associations:
- Cardiac anomalies
- Trisomies
- Beckwith Wiedeman syndrome.

35
Q

Gastroschisis:

A 
Para umbilical (usually right), anterior abdominal wall defect, without peritoneal covering.
Usually isolated finding
36
Q

Pentalogy of Cantrell:

A 
Ectopia cordis - extra thoracic heart.
Pericardial defect
Omphalocele
Diaphragmatic defect
Sternal disruption.
37
Q

Limb shortening DDX:

A 
Thonatophoric Dysplasia:
  Type 1:
   - Normal calverium
   - Micromelia (entire limb shortening)
   - Telephone receiver femur
   - Normal ossification / mineralisation, no fracture.
   - Platyspondyly, small chest.
   - Trident Hand

Type 2:
- cloverleaf calverium.

Osteogenesis Imperfecta:

  • micromelia (entire limb shortening)
  • Decreased ossification / decreased mineralisation
  • Multiple fractures
  • Improved visualisation of near field brain due to under ossified calverium.

Diabetic Embryopathy:
- Caudal regression - sacral agenesis, tailors posture.

Achondrogenesis.

38
Q

Abnormal placenta location:

A

Placenta previa
Placenta accrete spectrum
Succenturiate lobe

39
Q

Abnormal placental margin:

A

Marginal placental abruption
Circumvallate placenta
Marginal cord insertion

40
Q

Abnormal umbilical cord:

A 
Allantoic cyst with patent urachus
Omphalomesenteric duct cyst
Cystic Wharton Jelly (Aneuploidy)
Omphalocele mimics cord cyst
Physiologic gut herniation; completed by 12/40
Cord knot - mono amniotic twins.
41
Q

Solid / echogenic Lung Mass DDX:

A

CPAM:

  • tiny cysts, uniformly echogenic
  • Usually single, 1 lobe
  • Vascular supply from pulmonary artery.

Bronchopulmonary sequestration:

  • Uniformly echogenic, well marginated, triangular mass.
  • usually left sided.
  • Feeding vessel from aorta
  • Draining vessels IVC / azygous.

Congenital Diaphragmatic hernia:

  • Liver more hypoechoic
  • Bowel more hyper echoic.

Teratoma:

  • pericardial effusion
  • Ca++

Congenital lobar emphysema.

42
Q

Cystic Lung Mass Ddx:

A

If stomach above diaphragm = CDH:

  • cystic mass left chest
  • Absent stomach
  • Right heart deviation
  • Polyhydramnios

Stomach below diaphragm: CDH less likely:
Simple cyst:
- Broncogenic cyst
- Neuroenteric cyst

Complex cyst:

  • CPAM
  • Lymphangioma (extend beyond chest)
  • CDH (right sided).
43
Q

Abnormal Cardiac Axis:

A

Approach:
Check fetal stomach and heart on left.
- If both on right = situs inversus.
- Opposite sides = heterodoxy syndrome.

Cardiac axis normally 35-45 degrees.
If abnormal axis:
 - Pushed by mass / effusion
 - Pulled by small lung
 - Pushed inferiorly by mediastinal mass
 - Ectopia cordis.

Cardiac structure:

  • Atria
  • Ventricles
  • Crossing outflow tracts
  • AV concordance
  • Ventricle-arterial concordance.
  • 3 vessel view: normal PA - Aorta - SVC with trachea posteriorly.
44
Q

Congenital heart structural abnormalities: Right heart enlargement:

A

Shunt lesions, vascular malformation
Placental insufficiency
Left heart outflow obstruction

45
Q

Congenital heart structural abnormalities: Small Right Ventricle:

A

Pulmonary atresia / stenosis

Unbalanced AVSD

46
Q

Congenital heart structural abnormalities: Small left ventricle:

A

Hypoplastic left heart

Unbalanced AVSD

47
Q

Congenital heart structural abnormalities: Large right atrium:

A

Ebstein anomaly
Tricuspid dysplasia
Pulmonary stenosis / atresia

48
Q

Congenital heart structural abnormalities: Conotruncal malformation:

A

4 chamber view normal
Single outflow tract = truncus
Parallel outflow tracts = transposition.
Large aorta over riding VSD with seperate small pulmonary artery = TOF

49
Q

Congenital heart structural abnormalities: Ectopia Cordis

A

Extra thoracic / intra abdominal heart.
Assess for amniotic bands.

Pentalogy of Cantrell:

  • Anterior diaphragmatic hernia
  • Midline abdominal wall defect
  • Cardiac anomalies
  • Diaphragmatic pericardial defect
  • low sternal defect.
50
Q

Intra cranial cyst midline:

A

Cavum Verge:
- Posterior extension of cave septum pellucid.

Agenesis Corpus Callosum:

  • Parallel lateral ventricles
  • Colpocephaly, with tear shaped ventricles
  • Steer horn configuration frontal horns (coronal)
  • Abnormal spoke wheel ACA
  • Sagital radial sun ray distribution of gyri

Dandy Walker:

  • Vermis hypoplasia
  • Cystic dilation 4th ventricle
  • Large posterior fossa cyst, continuous with 4th ventricle
  • Elevated torcula

Alobar holoprosencephaly:

  • mono ventricle
  • Absent CSP, absent falx
  • Facial anomalies
  • T13

Semi lobar / lobar holoprosencephaly:

  • Mono ventricle anteriorly
  • absent CSP
  • Seperation into 2 lobes posteriorly

Arachnoid cyst

Cystic teratoma

Vein of Galen malformation

Arteriovenous fistula.

51
Q

Intra cranial cyst Lateral location DDX:

A

Choroid plexus cyst:

  • Cyst >2mm within choroid plexus
  • incidental, or associated with T18

Arachnoid cyst:

  • Extra axial cyst displaces brain
  • Avascular, over convexity.

Schizencephaly:

  • Wedge shaped defect from lateral ventricle to inner table lined by grey matter.
  • Open or closed lip.

Arteriovenous Malformation

Porencephaly.

52
Q

Posterior Fossa Cyst DDX:

A

Normal cerebellum size

  • Mega cisterna magna
  • arachnoid cyst.

Distorted / compressed / abnormal vermis:

  • Arachnoid cyst
  • Dandy Walker.

Normal vermis but rotated:
- Blake pouch cyst.

Mega cisterna Magna:
> 10mm, normal cerebellum, T18 association.

Dandy Walker:

  • Vermis dysgenesis
  • Posterior fossa cyst communicates with 4th ventricle
  • Elevated torcula
  • Associations: callosal dysgenesis, heterotopic cortical dysplasia, chromosomal anomalies, cardiac anomalies.

Blake Pouch Cyst:
- Elevated rotated Vermis

Arachnoid cyst:

  • no 4th ventricle communication
  • Vermis intact

Dural sinus malformation

Vein of Galen malformation

Joubert syndrome:
- Molar tooth sign.

53
Q

Findings diagnostic of pregnancy failure

A

Findings diagnostic of pregnancy failure
- crown-rump length (CRL) of ≥7 mm and no heartbeat on a transvaginal scan

  • mean sac diameter (MSD) of ≥25 mm and no embryo on a transvaginal scan
  • absence of embryo with heartbeat ≥2 weeks after a scan that showed a gestational sac without a yolk sac
  • absence of embryo with heartbeat ≥11 days after a scan that showed a gestational sac with a yolk sac
  • pregnancy with an embryo with no heart activity on initial scan and repeat scan ≥7 days later
  • sac with no embryo and an MSD <12 mm on initial scan that fails to double in size on a scan ≥14 days later
  • sac with no embryo and an MSD ≥12 mm on initial scan with no embryo heart activity on a scan ≥7 days later
  • embryo (irrespective of crown-rump length) without cardiac activity on initial scan and a scan ≥7 days later 2
54
Q

Findings suspicious but not diagnostic of pregnancy failure

A
  • crown-rump length (CRL) of <7 mm and no heartbeat
  • mean sac diameter (MSD) of 16-24 mm and no embryo
  • absence of embryo with heartbeat 7-13 days after a scan that showed a gestational sac without a yolk sac
  • absence of embryo with heartbeat 7-10 days after a scan that showed a gestational sac with a yolk sac
  • absence of embryo ≥6 weeks after last menstrual period
  • amnion seen adjacent to yolk sac, with no visible embryo (empty amnion sign)
  • enlarged yolk sac (>7 mm)
  • small gestational sac in relation to the size of the embryo (<5 mm difference between mean sac diameter and crown-rump length)
    large amniotic cavity (expanded amnion sign)
55
Q

Abnormal cervical length in pregnancy:

A

Cervical length < 3cm is abnormal.

56
Q

Fetal ventriculomegaly:

A

> 10mm

Primary CNS structural causes:

  • Aqueductal stenosis
  • Dandy Walker
  • Chiari II
  • Holoprosencephaly
  • CC genesis

Genetic:

  • T 13
  • T18

Destructive

  • Infection
  • Haemorrhage
  • Infarct

Idiopathic.

57
Q

Normal fetal kidney size:

A

Grow approx. 1mm per week of gestation, e.g. 20 week fetes should have renal length of 20mm.

58
Q

Staging twin twin transfusion:

A

VIVA approach:

  • Twin pregnancy
  • What type of twin –> T sign = monochorionic; likely will test twin to twin or TRAPs pathology.
  • Assess each twin fluid then bladder first, to assess recipient twin and donor twin
  • -> Recipient twin, increased amniotic fluid and large bladder
  • -> Donor twin, reduced fluid, small / absent bladder.

stage I: oligohydramnios/polyhydramnios
stage II: bladder not visible in donor twin
stage III: abnormal Dopplers in either twin
stage IV: hydrops fetalis in either twin*
stage V: in-utero demise of either twin

*almost always in the recipient; rarely in the donor if there is coexistent TAPS

59
Q

Single Umbilical artery associations:

A

IUGR

Umbilical arterial aneurysm

Twin reversed arterial perfusion sequence

When found with other fetal anomalies, it can be also be associated with:

Chromosomal anomalies

  • trisomy 21 (12.8% had an SUA),
  • trisomy 18 (50% had an SUA),
  • trisomy 13 (25% had an SUA)

Persistent right umbilical vein

congenital renal anomalies
- renal agenesis: occurs usually on the side where the artery is absent.

sirenomelia: mermaid syndrome / fusion lower limbs.

velamentous insertion of the cord

A DDx (14 decks)

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