**1. Introduction**

The thoracic anomalies represent a group of abnormalities that can be found either in the lung parenchyma or mediastinum. The thoracic cavity has a conical shape and is delimited at the posterior level by the sternum, at the superior level by the clavicle, at the lower level by the diaphragm, and at the lateral level by the ribs. In the thorax, the organs that are examined by the

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ultrasound are: the lungs, the heart and the mediastinum. The thoracic anomalies chapter refers to pulmonary and mediastinal fetal abnormalities, the cardiac abnormalities being a separate chapter. Congenital bronchopulmonary malformation comprises a group of abnormalities that are represented by the following entities: congenital cystic adenomatoid malformation (CCAM), bronchopulmonary sequestration (BPS), CCAM-BPS hybrid form, congenital diaphragmatic hernia (CDH), bronchogenic cyst, congenital high airway obstruction syndrome (CHAOS) and pulmonary hypoplasia/agenesis. Currently, it is recommended for the term bronchopulmonary anomalies to be used instead of congenital cystic adenomatoid malformation (CCAM) or bronchopulmonary sequestration (BPS), because it includes better the diagnosis given by the ultrasound, the prognosis and the therapeutic attitude. However, for teaching purposes, we will continue to keep the separate terms for each entity in part. The thoracic-pulmonary anomalies incidence is the following: CCAM—BPS around 40%, CDH around 40% and hydrothorax and other anomalies around 10% [1, 2].

• Presence of hydrothorax,

Thus, taking all these elements into account, we can classify the various thoracic anomalies

Thoracic Anomalies

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http://dx.doi.org/10.5772/intechopen.71959

• Unilateral anechoic lesions: CDH left sided, CCAM type I, unilateral fetal hydrothorax,

• Bilateral hyperechoic lesions: laryngeal atresia-CHAOS (congenital airway obstruction

Depending on the location of the chest masses, we should consider the following possibilities:

With the advantage of three-dimensional ultrasound (3D-US), we often can clarify the diagnosis of lung abnormalities. We can use 3D rendering, or reconstruction of the coronal plane, or minimal rendering mode, 3D with TUI (tomographic ultrasound image). With these ultrasound applications, it is possible to establish: liver position, liver outline, diaphragm outline, relationship between liver, pulmonary tissue and heart, presence of tho-

**2. Congenital cystic adenomatoid malformation of the lung (CCAM)**

Congenital cystic adenomatoid malformation of the lung (CCAM) is a lesion that is characterized by the presence of a mass of multicystic pulmonary tissue and is accompanied by bron-

• Right hemithorax: CDH, CCAM, BPS bronchogenic cyst, teratoma, hamartoma

• Posterior mediastinum: teratoma, neuroblastoma, esophageal duplication

• Unilateral hyperechoic lesions: CDH right sided, CCAM type III, BPS

• Median hyperechoic lesions: mediastinal teratoma or hemangioma

• Bilateral anechoic lesions: bilateral fetal hydrothorax

• Mediastinal shift.

bronchogenic cyst.

• Median anechoic lesion: CDH

• Left hemithorax: CCAM, CDH, BPS

• Anterior mediastinum: teratoma, thymoma

syndrome)

• Diaphragm: CDH

racic hypoplasia.

**2.1. Definition and incidence**

chial proliferation. Its occurrence can be explained by:

as following:

The ultrasound investigation of the thorax is based on emphasizing of the following parameters:


The standard echographic image for assessing the fetal thoracic anatomy is represented by the four-chamber view image of the fetal heart. If a thoracic lesion is evident in this section, then it is necessary to subsequently use the midsagittal, parasagittal and coronal sections. In the midsagittal and parasagittal view, the presence of the diaphragm and the net delimitation between the thorax and the abdomen can be identified. The objectives, in case a congenital bronchopulmonary malformation is detected, are as follows:


According to the European Respiratory Society, we need to keep in mind the following aspects [1]:


ultrasound are: the lungs, the heart and the mediastinum. The thoracic anomalies chapter refers to pulmonary and mediastinal fetal abnormalities, the cardiac abnormalities being a separate chapter. Congenital bronchopulmonary malformation comprises a group of abnormalities that are represented by the following entities: congenital cystic adenomatoid malformation (CCAM), bronchopulmonary sequestration (BPS), CCAM-BPS hybrid form, congenital diaphragmatic hernia (CDH), bronchogenic cyst, congenital high airway obstruction syndrome (CHAOS) and pulmonary hypoplasia/agenesis. Currently, it is recommended for the term bronchopulmonary anomalies to be used instead of congenital cystic adenomatoid malformation (CCAM) or bronchopulmonary sequestration (BPS), because it includes better the diagnosis given by the ultrasound, the prognosis and the therapeutic attitude. However, for teaching purposes, we will continue to keep the separate terms for each entity in part. The thoracic-pulmonary anomalies incidence is the following: CCAM—BPS around 40%, CDH around 40% and hydrothorax and

The ultrasound investigation of the thorax is based on emphasizing of the following parameters:

The standard echographic image for assessing the fetal thoracic anatomy is represented by the four-chamber view image of the fetal heart. If a thoracic lesion is evident in this section, then it is necessary to subsequently use the midsagittal, parasagittal and coronal sections. In the midsagittal and parasagittal view, the presence of the diaphragm and the net delimitation between the thorax and the abdomen can be identified. The objectives, in case a congenital

According to the European Respiratory Society, we need to keep in mind the following

• Cysts (number size, content), the presence or absence of a nutritive vessel,

other anomalies around 10% [1, 2].

164 Congenital Anomalies - From the Embryo to the Neonate

• The size and shape of the rib cage,

• The diaphragm curvature.

• Establishing the prognosis

aspects [1]:

• The mediastinal shift absence/presence,

• The description of the pulmonary anomaly • The exclusion of other associated anomalies

• The bilaterality/unilaterality of the lesion,

• The cystic or hyperechoic characteristic,

• The localization (lateral or central),

• Determining the effectiveness of the fetal therapy

• The aspect of the ribs, the pulmonary echogenicity,

bronchopulmonary malformation is detected, are as follows:

Thus, taking all these elements into account, we can classify the various thoracic anomalies as following:


Depending on the location of the chest masses, we should consider the following possibilities:


With the advantage of three-dimensional ultrasound (3D-US), we often can clarify the diagnosis of lung abnormalities. We can use 3D rendering, or reconstruction of the coronal plane, or minimal rendering mode, 3D with TUI (tomographic ultrasound image). With these ultrasound applications, it is possible to establish: liver position, liver outline, diaphragm outline, relationship between liver, pulmonary tissue and heart, presence of thoracic hypoplasia.
