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fetus considered not viable under how many weeks?
24
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what weeks are there a drastic increase in number and complexity of air spaces and vascular structires
16-24 wks
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fluid in lungs at birth leaves though what 3 ways
- mouth and nose
- pulmonary capillaries
- lymphatics in pulm vessles
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chest circum made at level of
4 ch heart
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fetus with narrow chest
- asphyxiating thoracic dystrophy
- associated with thanatophoric dwarfism (hypoplastic lungs)
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formular for pulm hypoplasia
CA-HA x 100/ CA
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fetal lung texture
- homogenous
- early - less echogenic than liver
- later- more echogenic than liver
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fetal breathing prominent when
- 2nd -3rd tri
- seasaw movement of chest 20sec during 20 min
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which lung has greater volume
right
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fetuses with lung masses may present with
abnormal cardiac rythm and fetal hydrops fro compression on venous return.
Pleural eff found with lung masses
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lungs do not develop with
oligo
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pulmonary hypoplasia
- decreaesed number of lung cells, airways, alveoli, decresaed organ weight
- PROM
- prolonged oligo- kidney function
- IUGR
- placenta
- dwarfism
-
renal obstruction
potters
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unilateral pulm agenesis
- rare
- usually with other malformations
-
prognosis for infants with pulm hypoplasia
80% dye after birth
-
cystic lung masses
- replace normal lung tissue
- shift in structures
- can be excised after birth
-
bronchogenic cysts
- most common lung cyst prenatal
- abnormal budding of foregut
- lack of commun with the trachea or bronch tree
- usually in mediastinum or lung- rarely below diaphragm
-
plueral eff or hydrothorax
accumulation of fluid in the pleural cavity
cardiac problems
most common reason is chylothorax- right side collection of fluid second to malformed thoracic duct
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chylothorax
- white milky fluid from lymphatics
- hydraminos
- right sided ple eff from malformed thoracic duct
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pleural eff can result from
- immune and non immune or nonimmune or cong heart failure
- chrom anomolies
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lymphangiectasia
dilated lymph node
-
pleural eff rarely before what week
- 15
- except in turners or downs
-
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pulmonary sequestration
- supernumerary lobe of lung seperated from normal bronch tree
- may be in lung sac or in its own (extralobar associated anomolies and hydrops)
- non funtional - blood from system
- can be in abd cavity with vascular connection
- echodense solid mass
- usually on left side lung rarely below diaphragm
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vongrnital cystic adenomatoid malformation CCAM
multicystic mass in lungs consisting of primitve lung tissue and abd brochial and bronch like structures
- happens in dev of lung 8-9 weeks
- one or more lobes rarely bilateral
- 3 forms
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CCAM 3 forms
- I macrocystic- one or more large cysts replace tisse (2-10cm)
- II macro with micro- multiple small cysts (<1cm)
- III micro- bulky large noncystic lesions, echodense mass, entire lung.
3 has worst outcome
poorer outcome with hydrops, poly, cardiac diviation
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congential bronchial atresia
- rare pulm anomonly focal obliteration of a segment of bronch lumen
- upper left lobe
- echogenic pulm mass lesion
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congenital lobar emphysema
- lobar over inflation of lung without destruction of alveolar septa
- upper left or middle lobe
- looks like micro CCAM
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congenital diaph hernia
- herniation of abd organs into chest from defect in diaph
- 1in 2000 to 1 in 5000
-
most common diaph hernia 90%
- posterior and lateral
- foramen of bockdalek
- left side with left organs
- shifts heart to right
-
anterior and medial hernia
- formen of morgagni
- communicate with pericardial sac
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hydrops not present with what side hernia
left side hernia unless associated fetal malformation
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ECMO
- extracorporeal membrane oxegenation
- block carotid to bypass pulm circulation to give the lung a chance to develop/mature before cicrc demands in place
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