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Prenatal MRI findings of fetuses with congenital high airway obstruction sequence.

Guimaraes CV, Linam LE, Kline-Fath BM, Donnelly LF, Calvo-Garcia MA, Rubio EI, Livingston JC, Hopkin RJ, Peach E, Lim FY, Crombleholme TM - Korean J Radiol (2009)

Bottom Line: Associated abnormalities were found in 4 of 7 (genetic syndromes in 2).Two fetuses were terminated and one fetus demised in utero.Four fetuses were delivered via ex utero intrapartum treatment procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. carolina.guimaraes@cchmc.org

ABSTRACT

Objective: To define the MRI findings of congenital high airway obstruction sequence (CHAOS) in a series of fetuses.

Materials and methods: Prenatal fetal MR images were reviewed in seven fetuses with CHAOS at 21 to 27 weeks of gestation. The MRI findings were reviewed. The MRI parameters evaluated included the appearance of the lungs and diaphragm, presence or absence of hydrops, amount of amniotic fluid, airway appearance, predicted level of airway obstruction, and any additional findings or suspected genetic syndromes.

Results: All the fetuses viewed (7 of 7) demonstrated the following MRI findings: dilated airway below the level of obstruction, increased lung signal, markedly increased lung volumes with flattened or inverted hemidiaphragms, massive ascites, centrally positioned and compressed heart, as well as placentomegaly. Other frequent findings were anasarca (6 of 7) and polyhydramnios (3 of 7). MRI identified the level of obstruction as laryngeal in five cases and tracheal in two cases. In four of the patients, surgery or autopsy confirmed the MRI predicted level of obstruction. Associated abnormalities were found in 4 of 7 (genetic syndromes in 2). Postnatal radiography (n = 3) showed markedly hyperinflated lungs with inverted or flattened hemidiaphragms, strandy perihilar opacities, pneumothoraces and tracheotomy. Two fetuses were terminated and one fetus demised in utero. Four fetuses were delivered via ex utero intrapartum treatment procedure.

Conclusion: MRI shows a consistent pattern of abnormalities in fetuses with CHAOS, accurately identifies the level of airway obstruction, and helps differentiate from other lung abnormalities such as bilateral congenital pulmonary airway malformation by demonstrating an abnormally dilated airway distal to the obstruction.

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Related in: MedlinePlus

22-week-old fetus with congenital high airway obstruction sequence.A. Axial T2-weighted single shot fast spin echo image shows marked placentomegaly (P). Note that fetus has centrally positioned and compressed heart (H), and large lung volumes (L).B. Coronal T2-weighted single shot fast spin echo image shows markedly enlarged lung volumes (L) and increase in lung signal, marked ascites (A), and dilated airway (arrow). Note inverted diaphragms.
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Figure 2: 22-week-old fetus with congenital high airway obstruction sequence.A. Axial T2-weighted single shot fast spin echo image shows marked placentomegaly (P). Note that fetus has centrally positioned and compressed heart (H), and large lung volumes (L).B. Coronal T2-weighted single shot fast spin echo image shows markedly enlarged lung volumes (L) and increase in lung signal, marked ascites (A), and dilated airway (arrow). Note inverted diaphragms.


Prenatal MRI findings of fetuses with congenital high airway obstruction sequence.

Guimaraes CV, Linam LE, Kline-Fath BM, Donnelly LF, Calvo-Garcia MA, Rubio EI, Livingston JC, Hopkin RJ, Peach E, Lim FY, Crombleholme TM - Korean J Radiol (2009)

22-week-old fetus with congenital high airway obstruction sequence.A. Axial T2-weighted single shot fast spin echo image shows marked placentomegaly (P). Note that fetus has centrally positioned and compressed heart (H), and large lung volumes (L).B. Coronal T2-weighted single shot fast spin echo image shows markedly enlarged lung volumes (L) and increase in lung signal, marked ascites (A), and dilated airway (arrow). Note inverted diaphragms.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2651442&req=5

Figure 2: 22-week-old fetus with congenital high airway obstruction sequence.A. Axial T2-weighted single shot fast spin echo image shows marked placentomegaly (P). Note that fetus has centrally positioned and compressed heart (H), and large lung volumes (L).B. Coronal T2-weighted single shot fast spin echo image shows markedly enlarged lung volumes (L) and increase in lung signal, marked ascites (A), and dilated airway (arrow). Note inverted diaphragms.
Bottom Line: Associated abnormalities were found in 4 of 7 (genetic syndromes in 2).Two fetuses were terminated and one fetus demised in utero.Four fetuses were delivered via ex utero intrapartum treatment procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. carolina.guimaraes@cchmc.org

ABSTRACT

Objective: To define the MRI findings of congenital high airway obstruction sequence (CHAOS) in a series of fetuses.

Materials and methods: Prenatal fetal MR images were reviewed in seven fetuses with CHAOS at 21 to 27 weeks of gestation. The MRI findings were reviewed. The MRI parameters evaluated included the appearance of the lungs and diaphragm, presence or absence of hydrops, amount of amniotic fluid, airway appearance, predicted level of airway obstruction, and any additional findings or suspected genetic syndromes.

Results: All the fetuses viewed (7 of 7) demonstrated the following MRI findings: dilated airway below the level of obstruction, increased lung signal, markedly increased lung volumes with flattened or inverted hemidiaphragms, massive ascites, centrally positioned and compressed heart, as well as placentomegaly. Other frequent findings were anasarca (6 of 7) and polyhydramnios (3 of 7). MRI identified the level of obstruction as laryngeal in five cases and tracheal in two cases. In four of the patients, surgery or autopsy confirmed the MRI predicted level of obstruction. Associated abnormalities were found in 4 of 7 (genetic syndromes in 2). Postnatal radiography (n = 3) showed markedly hyperinflated lungs with inverted or flattened hemidiaphragms, strandy perihilar opacities, pneumothoraces and tracheotomy. Two fetuses were terminated and one fetus demised in utero. Four fetuses were delivered via ex utero intrapartum treatment procedure.

Conclusion: MRI shows a consistent pattern of abnormalities in fetuses with CHAOS, accurately identifies the level of airway obstruction, and helps differentiate from other lung abnormalities such as bilateral congenital pulmonary airway malformation by demonstrating an abnormally dilated airway distal to the obstruction.

Show MeSH
Related in: MedlinePlus