Chest
Normal
Assessment pic
Clavicles provide the superior anatomic marker, diaphragm provides the inferior marker
displacement of the fetal heart is a primary sign of intrathoracic mass
Lung Development
most important element of fetal survival
GA is the most accurate predictor of lung maturity
oligohydramnios can delay maturation
require 3 elements: space, respiration, and normal amniotic fluid levels, otherwise get pulmonary hypoplasia
timeline:
16-18wks normal number of bronchi have developed
24 wks increased airspace and capillaries, with earliest time for viable delivery as surfactant production begins. Lecithin/Sphingomyelin ratio >2
>24 wks flattening of pulmonary epithelium with improved gas exchange, and the lung starts to look less echogenic than liver.
Grade III placenta indicates lung maturity always
femoral head epiphysis visualization occurs at 38wks
Diaphragm Development
6-14wks: septum transversum, body wall, and dorsal mesentery of esophagus should fuse with the pleuroperitoneal membrane
Congenital Diaphragmatic Hernia
posterolateral Bochdalek type (90%) usually left sided (90%)
others are anteromedial Morgagni type
50% have associated congenital anomalies
pulmonary hypoplasia develops from compressing of lung
need 20% of aerated possible lung for life
results in arterial hyperplasia causing pulmonary hypertension (thus persistent PDA)
U/S shows:
small AC (below 5th %le- poor prognosis)
abdominal organs in chest, no fluid filled stomach in abdomen
displacement of heart from midline
frequently polyhadramnios
Hydrops is indicates a poor prognosis
Cystic Adenomatoid Malformation
hamartoma of the lung, usually involving only one lobe or portion of it
usually large and noncompressible, can shift mediastinum and compress IVC
may be associated with hydrops, polyhydramnios and pulmonary hypoplasia
(thought to arise from obstructed bronchus and most shrink over time after 28wks. Those not shrinking may become symptomatic. Hard to discern between sequestration.)
type I one or more large cysts (2-10cm) with surrounding smaller cysts
type II: multiple small (<2cm) cysts of uniform size
type III: multiple tiny cysts (<0.5cm; microcystsic variant) that look like a solid echogenic
mass
poorer prognosis, but if survive delivery will do well
macrocysts (types I & II) can be aspirated, but usually reaccumulate
some resolve spontaneously
Pulmonary Sequestration
bronchopulmonary foregut abnormality supplied by a systemic artery
no communication with bronchial tree
extralobar (25%)
are the only type detectable in utero
haver their own visceral pleura and drain into systemic right atrial veins
90% left posterior basal segment
5% are below the diaphragm
60% associated with other anomalies such as diaphragmatic hernias
25% have foci of CCAM II
may develop hydrops or polyhydramnios
U/S homogeneous well defined solid triangular echogenic mass
intralobar (75%)
share visceral pleura with lung and drain via pulmonary veins to left atrium
no associated anomalies and may be acquired
Congenital Tracheal/Bronchial Atresia
focal obliteration of trachea or bronchus
usually left upper lobe with obstructed lung distending with fluid
Bronchogenic Cyst
rare forgut abnormal budding into bronchus, with midportion going to esophageal duplication and posterior to neurenteric cysts
occurs at 4-6wks, difficult to see on U/S
not associated with other anomalies
Pleural Effusion
bilateral are usually serous fluid associated with hydrops and are well defined triangular shaped with echogenic lung
unilateral (usually right) are chylothorax due to malformation of thoracic duct with isolated chromosomal abnormalities, trisomy 21, or Turner's (XO)
usually large, can get pulmonary hypoplasia, hydrops
treat with drain
text
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Clavicles provide the superior anatomic marker, diaphragm provides the inferior marker
displacement of the fetal heart is a primary sign of intrathoracic mass
Lung Development
most important element of fetal survival
GA is the most accurate predictor of lung maturity
oligohydramnios can delay maturation
require 3 elements: space, respiration, and normal amniotic fluid levels, otherwise get pulmonary hypoplasia
timeline:
16-18wks normal number of bronchi have developed
24 wks increased airspace and capillaries, with earliest time for viable delivery as surfactant production begins. Lecithin/Sphingomyelin ratio >2
>24 wks flattening of pulmonary epithelium with improved gas exchange, and the lung starts to look less echogenic than liver.
Grade III placenta indicates lung maturity always
femoral head epiphysis visualization occurs at 38wks
Diaphragm Development
6-14wks: septum transversum, body wall, and dorsal mesentery of esophagus should fuse with the pleuroperitoneal membrane
Congenital Diaphragmatic Hernia
posterolateral Bochdalek type (90%) usually left sided (90%)
others are anteromedial Morgagni type
50% have associated congenital anomalies
pulmonary hypoplasia develops from compressing of lung
need 20% of aerated possible lung for life
results in arterial hyperplasia causing pulmonary hypertension (thus persistent PDA)
U/S shows:
small AC (below 5th %le- poor prognosis)
abdominal organs in chest, no fluid filled stomach in abdomen
displacement of heart from midline
frequently polyhadramnios
Hydrops is indicates a poor prognosis
Cystic Adenomatoid Malformation
hamartoma of the lung, usually involving only one lobe or portion of it
usually large and noncompressible, can shift mediastinum and compress IVC
may be associated with hydrops, polyhydramnios and pulmonary hypoplasia
(thought to arise from obstructed bronchus and most shrink over time after 28wks. Those not shrinking may become symptomatic. Hard to discern between sequestration.)
type I one or more large cysts (2-10cm) with surrounding smaller cysts
type II: multiple small (<2cm) cysts of uniform size
type III: multiple tiny cysts (<0.5cm; microcystsic variant) that look like a solid echogenic
mass
poorer prognosis, but if survive delivery will do well
macrocysts (types I & II) can be aspirated, but usually reaccumulate
some resolve spontaneously
Pulmonary Sequestration
bronchopulmonary foregut abnormality supplied by a systemic artery
no communication with bronchial tree
extralobar (25%)
are the only type detectable in utero
haver their own visceral pleura and drain into systemic right atrial veins
90% left posterior basal segment
5% are below the diaphragm
60% associated with other anomalies such as diaphragmatic hernias
25% have foci of CCAM II
may develop hydrops or polyhydramnios
U/S homogeneous well defined solid triangular echogenic mass
intralobar (75%)
share visceral pleura with lung and drain via pulmonary veins to left atrium
no associated anomalies and may be acquired
Congenital Tracheal/Bronchial Atresia
focal obliteration of trachea or bronchus
usually left upper lobe with obstructed lung distending with fluid
Bronchogenic Cyst
rare forgut abnormal budding into bronchus, with midportion going to esophageal duplication and posterior to neurenteric cysts
occurs at 4-6wks, difficult to see on U/S
not associated with other anomalies
Pleural Effusion
bilateral are usually serous fluid associated with hydrops and are well defined triangular shaped with echogenic lung
unilateral (usually right) are chylothorax due to malformation of thoracic duct with isolated chromosomal abnormalities, trisomy 21, or Turner's (XO)
usually large, can get pulmonary hypoplasia, hydrops
treat with drain
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