Embed Size (px)
Citation preview
4/1/2019
1
Normal ‐ Anatomy
‐ Ultrasound planes
Pathology‐ Congenital Pulmonary Airway Malformation
‐ Bronchogenic Cyst
‐ Bronchial Atresia
‐ Congenital Lobar Emphysema
‐ CHAOS
‐ Hydrothorax
‐ Congenital Diagphragmatic Hernia
‐ Pulmonary Hypoplasia / Chest shape
Relatively small‐ Abnormalities subtle
Overview
Tell at the end….
Lungs/ Pleural space
Diaphragm
Thymus
Ribs/ Clavicle
Upper Abdomen
‐ Extra thoracic pathology
‐ Thoraco-abdominal
‐ Proportion
Fetal Thorax: Sagittal
Straight ribs
Lungs/ Pleural space
Diaphragm
Thymus
Ribs/ Clavicle
Upper Abdomen
Proportion
Fetal Thorax: Axial
Fetal Thorax: Coronal
Harder
Late first/ second trimester
Size
‐ Heart 50%
Shape
Relationships
Changes to echotexture
Masses
AxFetal Thorax: Looking for
RL
96 %
4/1/2019
2
? 2006
2006
?
Skeletal Dysplasia
Bell shaped
Increased C/T ratio
Pulmonary hypoplasia
Two Patterns (Badalin 1996)
‐ High Amplitude/ Low rate (Diaphragm)
‐ Low Amplitude Rapid Rate
Breathing
?
4/1/2019
3
Hiccups
‐ Acceptable
?
?
• Diaphragm or Lung movements caused by heart motion
What is not fetal breathing?
Diaphragm Lung
Not breathing Not breathing
What settings ?
Thorax: Technical
Settings
‐ DR
‐ Gray maps
‐ Temporal resolution
‐ ? Fetal heart
Thorax: Technical
Describe
?
4/1/2019
4
Combined term
‐ CCAM
+ /- Pulmonary Sequestration
Often hybrid lesion
1: 4000
Unilateral – 95% +
Arrested development
‐ Replaced dysplastic tissue
‐ Hamartomatous
Congenital Pulmonary Airway Malformation (CPAM)
Classification
Imaging‐ type I
‐ most common: 70%
‐ large cysts : 2-10 cm
‐ type II (this case)
‐ 15-20%
‐ cysts are <2 cm in diameter
‐ associations (inc BPS)
‐ type III
‐ 10%
‐ microcysts: <5 mm
Resection ‐ type IV
‐ unlined cyst/ single lobe
‐ indistinguishable from type I
‐ type 0
‐ very rare, lethal
‐ global arrest of lung development
CPAM
Rt
?
BPS
‐ Systemic blood supply
‐ Aorta
Intralobar/ Extralobar
Extralobar
‐ Pleural covering
‐ May occur in abdomen
Brochopulmonary Sequestration (BPS)
?
Type 1
Outcome ?
‐ Hydrops – Marker
CPAM
4/1/2019
5
?
Type 3
CPAM
?
Simple
Anechoic
Unilocular
Bronchogenic Cyst
?
Lower respiratory tract
‐ Bronchial atresia (Part)
Echogenic lung mass
Unilateral
‐ Appears to cross midline
‐ Overinflated
Difficult dx
‐ Looks like BPS CPAM
Managed – Symptomatically (Conservative vs Sx)
Congenital Lobar Emphysema
4/1/2019
6
?
Bronchial Atresia
‐ All one side
Bronchial Atresia
Rt
?
Bronchial Atresia
‐ All one side
CHAOS
‐ Congenital High Airway
Obstruction Syndrome
‐ Fetal airway
‐ Obstructed
‐ Enlarged lungs
‐ Inverted diaphragm
‐ Compressed heart
‐ EXIT procedure
Bronchial Atresia / CHAOS
Rt
Elective Caesarean Section
Airway established
‐ Laryngoscope/ Bronchoscope
‐ Tracheostomy
‐ Ventilation
Sounds easy? … Not!
‐ Fetal Risks
‐ Cord occlusion,
‐ Preserve placental function,
‐ Avoid contractions
‐ Maternal
‐ Significant ut. haemmorhage
The EXIT Procedure
www.youtube.com/watch?v=_Iou1ubHskA
?
4/1/2019
7
Isolated:
‐ “Hydrothorax”
Associations
‐ Hydrops
Transient / Unexplained
Batwing
Causes – Congenital Pleural Effusions
Pleural Effusion
?
?
Diaphragm
‐ Deficiency / Absence
85%
‐ Postero-lateral / Left
Congenital Diaphragmatic Hernia
Ultrasound
‐ Paradoxial diaphragm m’ment
Left Sided
‐ Cystic mass
‐ Absent stomach
‐ Heart deviation
‐ Liver (85%)
Right Sided
‐ ?Chest mass
‐ Liver
‐ Peristalsis
CDH
Predicting Outcome
Increased Mortality
‐ Involves liver (use vascularity)
‐ Pulmonary hypoplasia (small lung)
‐ Right worse than left
LHR
CDH
http://perinatology.com/calculators/LHR.htm
4/1/2019
8
Pathology
?
Pathology
Pulmonary Hypoplasia
Unilateral
Bilateral
‐ Skeletal Dysplasia
‐ Reduced Amniotic fluid
Ratios
‐ LHR
‐ Heart Circ / Thoracic (0.5)
MR / Another area
? … last one
? … last one
Extralobar Pathology- BPS, CPAM, Lymphangioma
“Diasappeared- T#
Small number of pathologies
Increase BMI- “missed”
Precise Dx
‐ Difficult
Review carefully
Overview
