Diagnostic ultrasound ( PDFDrive )

CHAPTER 36 The Fetal Chest 1259
A
B
C
D
FIG. 36.12 Congenital Primary Pulmonary Lymphangiectasia. (A) Axial and (B) sagittal sonograms of the fetal chest at 28 weeks’ gestation
demonstrate pleural effusions (arrow). The underlying lungs are heterogeneous. (C) Axial T2-weighted image conirms the presence of small
effusions and heterogenous lung parenchyma “nutmeg” in appearance. (D) Chest radiograph at 2 days of age demonstrates course interstitial
markings and small effusions, right greater than left.
examination of the course of the portal and hepatic veins is
helpful to demonstrate hepatic vessels extending into the chest. 177
he intraabdominal hepatic vein takes a curved course (Fig.
36.13E), and the let portal vein branches will be seen at or above
the diaphragm. 174
In a right-sided hernia, the liver herniates into the chest, and
mediastinal shit is to the let (Fig. 36.14, Video 36.6). Liver
echogenicity can appear similar to the lung, so visualization of
gallbladder and hepatic vessels in the thorax is helpful in conirming
the diagnosis. Bowel can also herniate, but the stomach is
located below the diaphragm. Because of kinking of the intrahepatic
inferior vena cava, ascites (with luid extending into the
chest) and hydrops can develop. Absence of the hypoechoic
muscular diaphragm on the right helps in diferentiating CDH
from other fetal chest masses.
Complete anatomic examination should be performed to
assess for presence of associated anomalies (25%-75%). Echocardiography
is indicated because congenital cardiac defects occur
in 10% to 35% of cases and decrease survival from 73% to 67%
if it is a minor defect or to 36% if it is a major complex cardiac
defect. 184
MRI is a useful adjuvant for conirming the diagnosis of a
CDH and assessing for additional abnormalities. MRI better
demonstrates the position of the liver and the amount of
herniation due to diferentiation of the hepatic lobe (bright on
T1-weighted imaging) from the compressed lung or a solid type