Fetall chest and abdomen anomaliess.pptx

Ultrasoundd

1. Fetal chest and abdomen anomalies July 16, 2024

2. Sonographic feature of fetal chest The fetal lungs appears as homogeneously echogenic tissue surrounding the heart, The lungs are separated by the hypoechoic , dome-shaped diaphragm from the abdominal organs. The fetal ribs are highly echogeni c, curved bony structures arising near the spine. Echogenicity increases as the lung develops July 16, 2024

3. Thoracic circumference and lung area July 16, 2024

4. Pleural effusion Fetal pleural effusion is rare, with an incidence of up to 1 in 15,000 pregnancies Primary pleural effusion is most often caused by chylothorax Secondary pleural effusion occurs in association with aneuploidy, infection, genetic syndromes, and other structural malformation July 16, 2024

5. Sonographic apearance Anechoic fluid collections in the pleural space(lung will look like floating in the fluid) Small effusions appear as an anechoic thin rim outlining the lungs and the mediastinum . Larger unilateral effusions result in mass effect causing medias tinal shift and flattening o r eversion of the diaphragm When the cause is hydrops it can occur unilaterally and progress to bilateral July 16, 2024

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7. Diaphragmatic hernia Congenital diaphragmatic hernia results from failure of the pleuroperitoneal canal to close The defect in the diaphragm allows herniation of viscera into the chest. The mass effect will impact cardiac and pulmonary dev’t July 16, 2024

8. US findings: Fluid filled , solid, or multicystic mass in the chest; Displacement of the heart and the mediastinum; Absence of the stomach in the abdomen; and Polyhydramnios . Chromosome anomalies and July 16, 2024

9. Fetal Abdomen Swallowing begins at 11 to 12 weeks GA. The fetal stomach should be filled with swallowed fluid by 18 weeks GA. If em p ty suggest abnormality although it can occur due to recent emptying of the stomach . July 16, 2024

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11. Liver Fetal liver has homogeneous echogenecity and the largest organ Hepatic enlargement has been documented in fetal anemia caused by isoimmunization , Calcifications might be seen but have no clinical significance When calcifications are noticed it is important to assess for any associated hepatic mass, for normal flow in the liver, for signs of infection, and for any structural or growth abnormalities . July 16, 2024

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14. Biliary system Gall bladder should appear oblong and anechoic in the anterior liver. In multiple series, visualization of the gallbladder was most common from 20 to 32 weeks . Non-visualization of the gallbladder is associated with cystic fibrosis, gallbladder atresia, and biliary atresia. None of the fetuses with isolated nonvisualization of the gallbladder had any adverse neonatal outcome July 16, 2024

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16. Pancreas and Spleen Pancreatic abnormalities reported prenatally include polycystic pancreas and annular pancreas. The diagnoses of annular pancreas were triggered by sonographic assessment for a dilated duodenum .(ass with duodenal atresia Spleen echogenic s tructure in the left side Abnormalities of the fetal spleen ( asplenia or polysplenia ) are associated with heterotaxy syndromes and warrant a detailed fetal cardiac examination Splenomegaly in isoimmunized fetuses correlates to the severity of fetal anemia. July 16, 2024

17. The visualized small bowel loops are normally less than 6 mm in diameter and less than 15 mm in length. The colon is visualized after 20 weeks as a tubular structure around the periphery of the abdomen. The colon progressively fills with meconium but does not exceed 23 mm in diameter The length of normal fetal kidneys in millimeters is approximately equal to GA in weeks. July 16, 2024

18. Cont’d Double bubble Fluid distension of the stomach and proximal duodenum. Fluid distension of the duodenum is abnormal and indicative of duodenal atresia or stenosis , annular pancreas, or volvulus . Down syndrome is commonly present. Half the cases have additional anomalies. Bowel obstruction Suggested by dilation of the small bowel of greater than 6 mm . Causes include jejunal or ileal atresia or stenosis , volvulus , meconium ileus , and enteric duplication. July 16, 2024

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21. Gastroschisis and Omphalocele Gastroschisis Results from a defect, 2 to 4 cm , in the anterior abdominal wall nearly always on the right side of the umbilicus. Bowel herniates through the defect and floats freely in the amniotic fluid with no covering membrane Normal cord insertion. Usually isolated July 16, 2024

22. Omphalocele The defect is midline at the umbilicus with herniation of abdominal contents into the base of the umbilical cord. Both liver and bowel are commonly present in the herniation. A membrane consisting of peritoneum and amnion covers the omphalocele . The umbilical cord inserts through the membrane. Associated anomalies are common (67% to 88%) July 16, 2024

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24. Urinary Obstruction The most common causes of hydronephrosis in the fetus are ureteropelvic junction obstruction, ectopic ureterocele , and posterior urethral valves. US evidences: Dilation of the renal pelvis greater than 10-mm AP diameter Greater than 50% of the AP diameter of the kidney in axial section Unequivocal caliectasis Assessment of bladder filling and amniotic fluid volume is necessary to determine the severity of obstruction . July 16, 2024

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28. Fetal Megacystis Fetal megacystis has been reported as early as 10 to 14 weeks’ gestation when the longitudinal bladder diameter is 7 mm or more In the chromosomally normal group, severe megacystis ( bladder length >15 mm) was invariably associated with progressive obstructive uropathy . However, if the bladder length was 7 to 15 mm, there was spontaneous resolution of the megacystis by 20 weeks in 90% of cases. July 16, 2024

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30. Causes of fetal megacystis Posterior urethral valves Urethral atresia /stricture Prune belly syndrome Megalourethra Cloacal malformation Megacystis-microcolon –intestinal hypoperistalsis syndrome July 16, 2024

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32. Renal cystic disease Multicystic dysplastic kidney appears as multiple noncommunicating cysts of varying size. Autosomal recessive polycystic disease Massive enlargement of both kidneys associated with oligohydramnios . The kidneys are predominantly echogenic with a sonolucent rim. Discrete cysts are usually not evident. July 16, 2024

33. Multicystic dysplastic kidney July 16, 2024

34. C on’t Autosomal dominant polycystic kidney The kidneys are enlarged but lack the sonolucent rim of autosomal polycystic kidney disease. Occasional discrete cysts are visualized. July 16, 2024