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Radiology
Congenital High Airway Obstruction Syndrome and Bronchial Atresia
Built from Obstetric Imaging
What’s inside
10 sections · 59 slides
Overview
- What you will learn here
Start with the normal fetus
You cannot spot the block until you know what an open airway looks like
- The fetal lung is a fluid-filled organ
- Proof the drain is open
- Levels of the airway
- The airway as one drainage pipe
What the disorder is
Two conditions, one mechanism, different levels of block
- Unpacking the name CHAOS
- Unpacking the name bronchial atresia
- Where the block sits
- How often does this happen?
- Why finding it before birth matters
Why it happens
Isolated, syndromic, or squeezed from outside
- Alone, or part of a syndrome
- Fraser syndrome: what to search for
- Blocks that press from outside
- The developmental fault behind it
What the block does to the fetus
Trapped fluid, swollen lungs, a squeezed heart
- One block, one chain of events
- Why blocked lungs get bigger
- Why the airways widen
- What swollen lungs do to the chest
- From a squeezed heart to hydrops
Seeing it on ultrasound
Plane by plane, the signs that clinch the diagnosis
- When and where to look
- The transverse view
- Trapped lungs and flat diaphragms at 22 weeks
- Axial view: both lungs enlarged and bright
- Coronal view: flat diaphragms and dark bronchi
- Two signs that clinch it
- Putting a number on the airway
- The bronchogram in a sagittal view
- The Doppler check
- Normal trachea and normal tracheal flow
- Colour flow moving through an open trachea
- The signs, all on one screen
- Bronchial atresia looks one-sided
- One trapped lung pushing the heart across
- Axial view of a one-sided trapped lung
- What to do once you have found it
MRI and the look-alikes
What magnetic resonance adds, and what can fool you
- What MRI adds
- Why the level of the block matters
- What ultrasound cannot tell you
- The main look-alike
- Reading a big bright lung
Treatment before birth
Doing nothing has a predictable ending
- What happens if nothing is done
- The EXIT procedure
- Surviving is not the same as doing well
- Opening the airway before birth
- What success looks like
- The path from scan to plan
After birth
The problems that follow a rescued airway
- The neonatal period
- The first year
- Later in childhood
- What decides the outlook
Take it away
What to remember and what to say
- What the referring physician needs to know
- Key points
- The whole topic in five lines
- References
- References (continued)
- References (continued)
- References (continued)
- Suggested readings
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition