Fetal Thorax

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Fetal Thorax
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Thorax

• The fetal thoracic cavity is bell shaped and
  bordered by the clavicles at the apex and the
  smooth hypoechoic diaphragm inferiorly
• The ribs smoothly marginated and regularly spaced
  form the lateral boundaries

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Fetal Chest
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Fetal Chest
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FETAL DIAPHRAGM
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Fetal thorax
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Fetal lungs
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FETAL DIAPHRAM
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Fetal liver/lung
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Congenital Diaphragmatic Hernia

• Protrusion of the abdominal contents into the
  thorax through a defect in the diaphragm wall
• Usually unilateral, more common on the left
  side
• Mortality is usually due to pulmonary
  insufficiency
• Associated with trisomies 13, 18, 21

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Diaphragmatic Hernia

• Compression of the heart and lungs causes
  pulmonary hypoplasia and fetal respiratory
  distress is secondary due to the pulmonary
  compression
• Loops of bowel, liver, other abdominal contents
  protrude into the thorax through the diaphragm
  displacing the heart

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Diaphragmatic Hernia

• Pulmonary hypoplasia develops
• Polyhydramnios - poor prognostic indicator,
  usually mortality is 50-80 in non-polyhydramnios

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Sono Criteria

• Displaced heart
• Mass within the thoracic cavity
• Small abdominal circumference
• Hydramnios
• Over 50 associated with structural and
  chromosomal abnormalities

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Diaphragmatic Hernia

• Left diaphragmatic hernia, the stomach and bowel
  are seen in the left thorax which displaces the
  heart

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Hydrothorax - Pleural Effusion

• Anechoic fluid collection within the pleural
  cavity that may appear as isolated lesions or
  secondary to multiple fetal anomalies
• May be isolated but in most cases it is
  associated with either maternal or fetal
  disorders
• Usually a poor prognosis when bilateral effusions
  are seen, which is usually associated with
  chromosomal disorders

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Pleural Effusion

• Appear as anechoic fluid collections in the fetal
  chest that conform to the normal chest and
  diaphragmatic contour
• Because fetal hydrothorax is associated with a
  poor outcome and significantly increased risk of
  pulmonary hypoplasia, aspiration and catheter
  drainage of large effusions have been
  accomplished antenatally with moderate success
• Commonly seen in
• Hydrops fetalis
• Congestive heart failure
• Chromosomal abnormalities

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Pulmonary Hypoplasia

• Incomplete or insufficient lung development
• A decrease in lung volume for gestational age
• It is an important source of postnatal morbidity
  and mortality
• Four factors are most important for normal lung
  development
• Adequate gestational duration
• Adequate amniotic fluid volume
• Adequate intrathoracic space
• Adequate fetal breathing movement

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Pulmonary Hypoplasia

• Associated with a poor prognosis
• It is rarely of primary origin, it is usually
  secondary to lung compression most commonly
  caused by prolonged oligohydramnios often caused
  by kidney abnormalities
• Causes are numerous and are related to
  compression from intrathoracic masses and
  abdominal masses that prevent the downward
  movementof the diaphragm
• Causes of pulmonary hypoplasia include
• Diaphragmatic hernia, pleural effusion, CAM,
  Renal agenesis

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Pulmonary Hypoplasia

• Lung hypoplasia may be diagnosed by a small chest
  cavity in relation to a larger abdominal cavity
  or a prominent heart (that takes up more than one
  third the area of the thorax on a transverse
  view) in a fetus without cardiac disease

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Pulmonary Hypoplasia

• Thoracic circumference to abdominal circumference
  ratios can be used, the normal ratio has a mean
  of .89 and measurements under .77 are considered
  abnormal and suggestive of lethal pulmonary
  hypoplasia

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Sono Findings

• Reduction in lung volume
• Oligohydramnios
• Look for chromosomal anamolies, renal anomalies
  and premature rupture of membranes

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Pulmonary Hypoplasia
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Pulmonary Hypoplasia
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Hydrothorax
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Hydrothorax
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Hydrothorax
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Hydrothorax
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Hydrothorax
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Hydrothorax
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Fetal thorax
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Fetal thorax
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Fetal thorax
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Congenital Cystic Adenomatoid

• Cystic adenomatoid Malformation (CAM) - these
  lesions are seen in the lungs
• Account for about 25 of congenital lung lesions
• Can appear solid, mixed or as a cystic mass that
  occupies space in the lungs
• May displace the heart

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Congenital Cystic Adenomatoid

• Associated with renal, cardiac and GI
  malformations
• As with all space occupying lung masses, they may
  be associated with fetal hydrops fetalis,
  ascites and polyhydramios

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Cystic Adenomatoid
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Cystic Adenomatoid
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Congenital Cystic Adenomatoid
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Congenital Cystadenomatoid
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Congenital Cystadenomatoid
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Congenital Cystic Adenomatoid
Surrounded by pleural effusion
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Lecithin/Sphingomyelin (L/S)

• L/S Ratio
• Lung development generally begins at about 24
  weeks gestation
• The lungs secrete phospholipids that play a key
  role in the functional integrity of the fetal
  lung at delivery

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Lecithin/Sphingomyelin (L/S)

• L/S Ratio
• If these phospholipids are not present in
  sufficient quanities at birth the fetal alveoli
  will collapse and the fetus will not receive
  enough oxygen to survive, this usually affects
  fetuses born prematurely

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L/S Ratio

• A L/S ratio of 2 or greater represents mature
  fetal lungs
• Maternal diabetes can create delayed lung
  maturity
• Maternal HTN can create accelerated fetal lung
  maturity

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Lung Cyst