Noncardiac Thoracic Malformations

and Marcelo Zugaib4



(1)
São Paulo University, Bauru, Brazil

(2)
Parisian University, Bauru, France

(3)
Member of International Fetal Medicine and Surgery Society, Bauru, Brazil

(4)
Obstetrics, University of São Paulo, Bauru, Brazil

 



Fetal thorax evaluation through ultrasound is a fundamental step of the morphological examination. The noncardiac thoracic malformations (basically pulmonary and diaphragmatic defects) must always be investigated, owing to high perinatal morbidity and mortality rates of these abnormalities.

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Fig. 8.1
Right longitudinal cut of fetal thorax and abdomen showing a normal right fetal diaphragm (arrows) at 22 weeks. COR heart, PUL right lung. Notice that lung is more echogenic than liver at this gestational age


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Fig. 8.2
Left longitudinal cut of fetal thorax and abdomen showing a normal left fetal diaphragm (small arrows) at 22 weeks. E stomach, H heart, D diaphragma


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Fig. 8.3
Fetal longitudinal section showing the stomach abnormally herniated in the thorax €, in the context of a left fetal diaphragmatic hernia. CD remaining diaphragmatic dome, AO descending aorta, CO heart


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Fig. 8.4
Left longitudinal cut of fetal thorax and abdomen showing a congenital diaphragmatic hernia—CDH (vertical arrows) in a 33 weeks fetus, stomach is herniated into the fetal thorax. C heart, E stomach


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Fig. 8.5
Transversal view of fetal thorax showing stomach herniation into the thorax, one can see stomach at the same level of fetal heart with deviation of fetal heart to the right in a case o CDH. E stomach, AD right atrium, VE left ventricle, COL column


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Fig. 8.6
Left longitudinal cut of fetal thorax and abdomen at 25 weeks showing fetal stomach (E) herniated into the thorax just beside fetal heart (C). D remaining diaphragm. (we thank Dr Marie Cecile Aubry for this image)


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Fig. 8.7
Right diaphragmatic hernia, in 29 weeks fetus. Left: note the topic stomach in the abdome (EST) and normal left diaphragm (DIAF) (COR=heart). Right: transversal thorax cut showing fetal heart shifted to the left (COR) and well as liver presence in fetal thorax, occupying all the right hemithorax (FIG). Also note fetal ascites (black arrow)


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Fig. 8.8
Bilateral congenital diaphragmatic hernia in a transverse section. Note the presence of the stomach at the same level as the heart and, at the same time, at the upper portion, the presence of the herniated liver in the thorax, in which case the mediastinum becomes centered because the left dome hernia deviates the heart to the right, but the associated right hernia makes the mediastinum relatively centered. This alerts the investigator in a unilateral hernia to make sure that it is not bilateral


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Fig. 8.9
Paramedian longitudinal cut to the left, showing the gastric bubble in the fetal thorax (e) at the same level as the heart (c), in early gestational age (18 weeks). D remaining diaphragm


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Fig. 8.10
Transverse section of the fetal thorax in left diaphragmatic hernia cases, with the heart deviated to the right (c), showing how the measurement of two axes of the remaining right lung should be made (calipers), to obtain the lung/head relationship, as it is obtained by multiplying two lung diameters (calipers), divided by the cephalic circumference value


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Fig. 8.11
Same section as Fig. 8.10, but in a fetus at 18 weeks, showing the herniated gastric bubble in the thorax (E). C heart, D remaining diaphragm


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Fig. 8.12
Right longitudinal cut of fetal thorax and abdomen at 29 weeks showing CAM (cystic adenomatoid malformation of the lung) at the lower lobe of right lung. RD fetal right kidney, COR heart


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Fig. 8.13
Paramedian longitudinal cut to the left showing adenomatoid malformation (CAM) at the inferior portion of left lung. Note that the diaphragm is normal (arrows), in order to differentiate from CAM from diaphragmatic hernia


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Fig. 8.14
Same case as previous, in transversal cut showing multiple cystic adenomatoid images (DAPC) in left lung, of the macrocystic type, with mediastinal deviation to the right, note the right cardiac ventricule leaning towards the rib, in the anterior part of the picture

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Dec 28, 2017 | Posted by in GYNECOLOGY | Comments Off on Noncardiac Thoracic Malformations
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