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FETAL CHEST FETAL HEART

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FETAL CHEST FETAL HEART. FETAL CHEST. DIAPHRAGM Assess diaphragm (thin echogenic line) Diaphragm hernias Lung and bowel similar echogenicity- Look for peristalsis Left easier to see than right due to gastric bubble LUNGS Look for pulmonary masses CCAM Sequestration Pulmonary hypoplasia - PowerPoint PPT Presentation

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Page 1: FETAL CHEST FETAL HEART

FETAL CHESTFETAL HEART

Page 2: FETAL CHEST FETAL HEART

FETAL CHESTDIAPHRAGM

◦ Assess diaphragm (thin echogenic line) Diaphragm hernias

Lung and bowel similar echogenicity- Look for peristalsis

Left easier to see than right due to gastric bubble

LUNGS◦ Look for pulmonary masses

CCAM Sequestration

◦ Pulmonary hypoplasiaPLEURA - effusionsMEDIASTINUM - masses

Page 3: FETAL CHEST FETAL HEART

CONGENITAL DIAPHRAGM HERNIABochdalek - 90% on left; most unilatAll should have amniocentesis and

dedicated echoSecondary pulmonary hypoplasia is

major cause of mortalityFindings

◦ Polyhydramnios◦ Stomach/bowel/liver adjacent to heart◦ Peristalsis in chest◦ Mediastinal shift◦ Absent gastric bubble◦ Reduced abdominal circumference

compared to rest of fetal biometry

Page 4: FETAL CHEST FETAL HEART

Associated anomalies◦ Aneuploidy (T18, T21); NTD; CHD; malrotation, omphalocele

DDX◦ CCAM◦ Other cystic masses such as foregut duplication cysts are

rare

Page 5: FETAL CHEST FETAL HEART

CCAM Most common fetal lung mass Types I-III

◦ Types I and II macroscopic cysts >5mm with good prognosis and hydrops is rare

Small risk of malignant degeneration (rhabdomyosarcoma) Imaging

◦ Macroscopic types appear cystic◦ Microscopic types appear solid (echogenic)

Pulmonary hypoplasia of normal lung - degree determines prognosis Mediastinal shift - cardiac compromise; polyhydramnios (impaired

swallowing) Associations (type II)

◦ Cardiac anomalies◦ Pulmonary sequestration◦ Pectus excavatum◦ Jejunal atresia◦ Renal agenesis, prune-belly syndrome

Pathology◦ Hamartomatous proliferation of terminal bronchioles◦ Cysts lined by respiratory epithelium and communicate with airways at birth

Page 6: FETAL CHEST FETAL HEART

CCAM

Page 7: FETAL CHEST FETAL HEART

EXTRALOBAR SEQUESTRATION More common in males (4:1) 90% LLL or below diaphragm Always airless as it has its own pleural envelope and no

communication with bronchial tree Systemic arterial supply - Aorta 80% Systemic venous drainage - IVC, azygos, portal v Imaging Findings

◦ Solid hyperechogenic mass◦ Look for systemic arterial supply on Doppler◦ Polyhydramnios◦ Hydrops

Associations 65%◦ CDH◦ Cardiac◦ GI, Renal, Vertebral anomalies

Often regress in utero DDX

◦ CCAM◦ Congential lobar emphysema (initially filled with fetal fluid)◦ Neuroblastoma

Page 8: FETAL CHEST FETAL HEART

SEQUESTRATION

Page 9: FETAL CHEST FETAL HEART

PULMONARY HYPOPLASIAAgenesis – complete absence of one or both lungs

(airways, alveoli, and vessels)Aplasia – absence of lung except for a rudimentary

bronchus that ends in a blind pouchHypoplasia – decrease in number and size of

airways and alveoli◦ Primary◦ Secondary

Bilateral - Oligohydramnios (Potter’s sequence); Skeletal dysplasia

Unilateral - CCAM; Sequestration; CDH; Hydrothorax

Imaging◦ Reduced thoracic circumference (<2SD) is suggestive◦ Fetal lung maturity best sssessed with

lecithin:sphingomyelin ratio in amniotic fluid◦ Echogenic pattern unreliable marker for maturity

Page 10: FETAL CHEST FETAL HEART

PLEURAL EFFUSION = abnormalFetal hydropsChromosomal Underlying mass InfectionLymphangiectasiaChylothorax - assoc with T21 and Turner’s

MEDIASTINAL MASSESAnterior Medistinum

◦ Teratoma◦ Cystic hygroma◦ Normal Thymus

Posterior Mediastinum◦ Neurogenic tumours◦ Enteric cyst

Page 11: FETAL CHEST FETAL HEART

FETAL HEARTTechnique Abdominal situs view

◦ 4-chamber view◦ LVOT

Posterior/central to RVOT Runs left to right

◦ RVOT Anterior to LVOT Runs right to left Bifurcates early: DA and RPA Check for antegrade flow in DA Anatomical trifurcation: DA, RPA, LPA

◦ 3-vessel view amniocentesis indicated in all abnormal: 15-40% will have

chromosomal anomalies ventricles/atria are of roughly same size as other ventricle/atria 3 in 1 rule: heart fills 1/3 of axial chest Cardiac circumference 1/2 chest circumference Length atrial septum: ventricular septum 1:2 Normal HR: 120-160bpm, SR

Page 12: FETAL CHEST FETAL HEART

Best seen on Four-Chamber View◦ Septal defect◦ Endocardial cushion defect (AVSD)◦ Hypoplastic left heart◦ Ebstein’s anomaly◦ Critical AS◦ Coarctation

Page 13: FETAL CHEST FETAL HEART

Best Seen on Outflow Tract Views◦ Tetralogy of Fallot◦ Transposition◦ Truncus Arteriosus◦ Pentalogy of Cantrell

Page 14: FETAL CHEST FETAL HEART

3-VESSEL VIEW

Page 15: FETAL CHEST FETAL HEART

Maternal Risk Factors for CHDDiabetesInfection - rubella, CMVSLEDrugs - EtOH, Phenytoin, lithiumFHX of heart disease, previous

child with CHDArrhythmia

Page 16: FETAL CHEST FETAL HEART

VSDMost common CHD (1:1000)Membranous 80% vs Muscular 10% vs

Outlet (ECD) 5%Don’t mistake membranous to

muscular transition for VSD

Page 17: FETAL CHEST FETAL HEART

Endocardial Cushion Defect40% have Trisomy 21EC forms lower atrial septum,

superior ventricular septum, anterior MV leaflet and septal TV leaflet

Page 18: FETAL CHEST FETAL HEART

Transposition of Great VesselsAorta arises from RV and pulmonary trunk

from LVAorta and pulmonary artery are parallel

instead of perpendicular to each other

Page 19: FETAL CHEST FETAL HEART

Tetralogy of Fallot Tetralogy

◦ Infundibular RV outflow tract stenosis◦ Overriding aorta◦ VSD◦ Hypoplastic RV

LV and RV are symmetric due to equal pressures Often missed on 4-chamber view

Page 20: FETAL CHEST FETAL HEART

Ebstein’s AnomalySeptal and posterior leaflets of tricuspid valve

prolapse and are integrated into RV wallAtrialisation of RVLarge RA due to massive regurgMaternal lithium is a risk factor

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Pulmonary AtresiaHypoplastic RA and RVPulmonary artery calibre may be

normalReversed flow in DA

Page 22: FETAL CHEST FETAL HEART

Pericardial Effusion>2mmAssociated with hydrops fetalis,

congenital infection and cardiac anomalies

Look for fluid in other compartments (hydrops)

Look for signs of congential infections◦Cerebral calcification◦Hepatic calcifciation◦Echogenic bowel

Page 23: FETAL CHEST FETAL HEART

Endocardial FibroelastosisIncreased echogenicity of

endocardiumVentricular dilatation and poor

contractility

Ectopia Cordis

Page 24: FETAL CHEST FETAL HEART

Rhabdomyoma Hamartoma of myocytes Strong association with Tuberous Sclerosis

◦ 50-85% of fetuses with it have TS◦ 50% of TS have it

Echogenic mass, usually intraventricular, can arise from IV septum

Page 25: FETAL CHEST FETAL HEART

FETAL ARRHYTHMIASPAC and PVC common and benignSVT is the most common

tachyarrhythmia - CMX hydropsFetal bradycardia (HR <100 for

>10sec)◦ If persistent - consider structural cardiac

defects or maternal CVDFetal heart block

◦ 40-50% have structural abnormality - usually lethal

◦ Associated with maternal SLE, RA, Scleroderma