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Fetal Thorax

CardioVascular abnormalities

by frequency of abnormalities on 4 chamber fetal US view

  1. Hypoplastic right or left ventricle

  2. Single ventricle

  3. AtrioVentricular (endocardial cushion) defect

  4. Large ventricular septal defect

  5. Double outlet right ventricle

  6. Ebstein’s anomaly: enlarged Right atrium

  7. Pulmonary atresia

  8. Cardiac tumors: Rhabdomyoma (TS)

  9. Ectopia cordis: assoc. w/ omphalocele

  10. Situs inversus

  11. Large atrial septal defect

  12. TOF: Tetralogy of Fallot

  13. Cardiomyopathy

  14. Aortic stenosis

  15. Coarctation of aorta

Fetal hydrops

Immune mediated: Rh incompatibility;
Non-immune hydrops:
Cardiac failure: arrhythmias, anemias, myocarditis, shunts, twin-twin transfusion sy
Decreased plasma oncotic pressure: hepatitis, nephrotic sy
Increased capillary permeability: anoxia
Obstruction of venous return:
Obstruction of lymphatic flow: Turner’s sy

Congenital Diaphragmatic Hernia CDH

most common intrathoracic extracardiac fetal anomaly; posterolateral Bochdalek (90%), anteromedial Morgagni (10%); Stomach located on the left side of the chest, no stomach bubble below the diaphragm, heart displaced upward or to the right; Morgagni typically herniated into pericardial sac without cardiac position change; assoc. w/ pulmonary hypoplasia

Cystic Adenomatoid Malformations CAM

hamartomatous involvement of lung; Type 1: large cysts (2 to 10 cm in diameter); Type II: smaller macroscopic cysts < 1 cm; Type III: multiple small bronchiole-like structures - hyperechoic mass; Often a CAM will become less prominent as pregnancy progress

Bronchopulmonary Sequestration

Intralobar without own pleural covering; Extralobar w/ its own pleural covering and own arterial supply from thoracic aorta (usually conical or triangular shape); hyperechoic mass at the lung base

Bronchogenic (lung) Cysts & Duplication (GI) Cysts

simple cysts as chest masses

Laryngeal Atresia

lethal, secretions from the lung cannot be expelled; lungs increase in echogenicity and become enlarged, lungs can compress the heart and invert the hemidiaphragms

DDx of cystic extracardiac intrathoracic masses: Bochdalek CDH, CAM I and CAM II, bronchogenic and duplication cysts, pulmonary sequestration

DDx of solid extracardiac intrathoracic masses: Morgagni and some Bochdalek CDH, CAM III, bronchopulmonary sequestration