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Fetal upper mediastinum — normal and abnormal findings in obstetric ultrasound screening
, 1
Affiliations- Department of Obstetrics and Perinatology, Jagiellonian University Medical College, Cracow, Poland
open access
Abstract
Fetal cardiac assessment is an integral part of the obstetric ultrasound. The inclusion of the outflow tracts and the three-vessel
and tracheal view into the ultrasound screening enhances the detection rate for cardiovascular anomalies. Both, international
and Polish guidelines recommend routine evaluation of the upper mediastinum. The aim of the study was to present
the principles for assessing the structures of the upper mediastinum in normal conditions and to draw attention to the
pathologies which may be visible in this plane.
Abstract
Fetal cardiac assessment is an integral part of the obstetric ultrasound. The inclusion of the outflow tracts and the three-vessel
and tracheal view into the ultrasound screening enhances the detection rate for cardiovascular anomalies. Both, international
and Polish guidelines recommend routine evaluation of the upper mediastinum. The aim of the study was to present
the principles for assessing the structures of the upper mediastinum in normal conditions and to draw attention to the
pathologies which may be visible in this plane.
Keywords
upper mediastinum; three-vessel view; three-vessel and tracheal view; heart defects
About this articleTitle
Fetal upper mediastinum — normal and abnormal findings in obstetric ultrasound screening
Journal
Issue
Article type
Review paper
Pages
620-628
Published online
2020-10-30
Page views
1131
Article views/downloads
1907
DOI
Pubmed
Bibliographic record
Ginekol Pol 2020;91(10):620-628.
Keywords
upper mediastinum
three-vessel view
three-vessel and tracheal view
heart defects
Authors
Anna Wojtowicz
Hubert Huras
References (36)- DeVore GR. The prenatal diagnosis of congenital heart disease--a practical approach for the fetal sonographer. J Clin Ultrasound. 1985; 13(4): 229–245.
- Allan LD, Crawford DC, Chita SK, et al. Prenatal screening for congenital heart disease. BMJ. 1986; 292(6537): 1717–1719.
- Copel JA, Pilu G, Green J, et al. Fetal echocardiographic screening for congenital heart disease: the importance of the four-chamber view. Am J Obstet Gynecol. 1987; 157(3): 648–655.
- Sharland GK, Allan LD. Screening for congenital heart disease prenatally. Results of a 2 1/2-year study in the South East Thames Region. Br J Obstet Gynaecol. 1992; 99(3): 220–225.
- Benacerraf BR. Sonographic detection of fetal anomalies of the aortic and pulmonary arteries: value of four-chamber view vs direct images. AJR Am J Roentgenol. 1994; 163(6): 1483–1489.
- Tegnander E, Eik-Nes SH, Johansen OJ, et al. Prenatal detection of heart defects at the routine fetal examination at 18 weeks in a non-selected population. Ultrasound Obstet Gynecol. 1995; 5(6): 372–380.
- Stoll C, Dott B, Alembik Y, et al. Evaluation and evolution during time of prenatal diagnosis of congenital heart diseases by routine fetal ultrasonographic examination. Ann Genet. 2002; 45(1): 21–27.
- Friedberg MK, Silverman NH, Moon-Grady AJ, et al. Prenatal detection of congenital heart disease. J Pediatr. 2009; 155(1): 26–31, 31.e1.
- Paladini D, Rustico M, Todros T, et al. Conotruncal anomalies in prenatal life. Ultrasound Obstet Gynecol. 1996; 8(4): 241–246.
- Yoo SJ, Lee YH, Kim ES, et al. Three-vessel view of the fetal upper mediastinum: an easy means of detecting abnormalities of the ventricular outflow tracts and great arteries during obstetric screening. Ultrasound Obstet Gynecol. 1997; 9(3): 173–182.
- Achiron R, Glaser J, Gelernter I, et al. Extended fetal echocardiographic examination in detection of cardiac malformations in low risk women. BMJ. 1992; 304: 671–4.
- Yagel S, Cohen SM, Achiron R. Examination of the fetal heart by five short-axis views: a proposed screening method for comprehensive cardiac evaluation. Ultrasound Obstet Gynecol. 2001; 17(5): 367–369.
- Yagel S, Arbel R, Anteby EY, et al. The three vessels and trachea view (3VT) in fetal cardiac scanning. Ultrasound Obstet Gynecol. 2002; 20(4): 340–345.
- Viñals F, Heredia F, Giuliano A. The role of the three vessels and trachea view (3VT) in the diagnosis of congenital heart defects. Ultrasound Obstet Gynecol. 2003; 22(4): 358–367.
- Tongsong T, Tongprasert F, Srisupundit K, et al. The complete three-vessel view in prenatal detection of congenital heart defects. Prenat Diagn. 2010; 30(1): 23–29.
- Carvalho JS, Allan LD, Chaoui R, et al. ISUOG Practice Guidelines (updated): sonographic screening examination of the fetal heart. Ultrasound Obstet Gynecol. 2013; 41(3): 348–359.
- Donofrio MT, Moon-Grady AJ, Hornberger LK, et al. American Heart Association Adults With Congenital Heart Disease Joint Committee of the Council on Cardiovascular Disease in the Young and Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Council on Cardiovascular and Stroke Nursing. Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation. 2014; 129(21): 2183–2242.
- Słodki M, Respondek-Liberska M. [Proposal of screening fetal heart examination form granted by Polish Ministry of Health Program Kardio-Prenatal 2008]. Ginekol Pol. 2009; 80(6): 466–470.
- Sekcja Ultrasonografii Polskiego Towarzystwa Ginekologicznego. [Polish Gynecological Society--Ultrasound Section Guidelines on ultrasound screening in uncomplicated pregnancy (2 December 2011)]. Ginekol Pol. 2012; 83(4): 309–315.
- Rekomendacje Sekcji Ultrasonografii Polskiego Towarzystwa Ginekologicznego w zakresie przesiewowej diagnostyki ultrasonograficznej w ciąży o przebiegu prawidłowym – 2015 r. Ginekol Pol. 2015; 86: 551–559.
- Wójtowicz A, Respondek-Liberska M, Słodki M, et al. The significance of a prenatal diagnosis of right aortic arch. Prenat Diagn. 2017; 37(4): 365–374.
- Paladini D. How to identify the thymus in the fetus: the thy-box. Ultrasound Obstet Gynecol. 2011; 37(4): 488–492.
- Cho JY, Min JY, Lee YH, et al. Diameter of the normal fetal thymus on ultrasound. Ultrasound Obstet Gynecol. 2007; 29(6): 634–638.
- Chaoui R, Heling KS, Lopez AS, et al. The thymic-thoracic ratio in fetal heart defects: a simple way to identify fetuses at high risk for microdeletion 22q11. Ultrasound Obstet Gynecol. 2011; 37(4): 397–403.
- Sinkovskaya E, Abuhamad A, Horton S, et al. Fetal left brachiocephalic vein in normal and abnormal conditions. Ultrasound Obstet Gynecol. 2012; 40(5): 542–548.
- Chaoui R, Heling KS, Sarioglu N, et al. Aberrant right subclavian artery as a new cardiac sign in second- and third-trimester fetuses with Down syndrome. Am J Obstet Gynecol. 2005; 192(1): 257–263.
- Wójtowicz A, Ochrem D, Dobosz A, et al. Neonatal Marfan syndrome diagnosed prenatally. Ginekol Pol. 2017; 88(1): 45.
- Kailin JA, Santos AB, Yilmaz Furtun B, et al. Isolated coarctation of the aorta in the fetus: A diagnostic challenge. Echocardiography. 2017; 34(12): 1768–1775.
- Edwards J. Vascular rings and slings. In: Moller J. ed. Fetal, Neonatal, and Infant Cardiac Disease. Appleton & Lange, Norwalk 1990: 745–754.
- Achiron R, Rotstein Z, Heggesh J, et al. Anomalies of the fetal aortic arch: a novel sonographic approach to in-utero diagnosis. Ultrasound Obstet Gynecol. 2002; 20(6): 553–557.
- Chaoui R, Thiel G, Heling KS. Prevalence of an aberrant right subclavian artery (ARSA) in fetuses with chromosomal aberrations. Ultrasound Obstet Gynecol. 2006; 28: 414.
- Paladini D, Sglavo G, Pastore G, et al. Aberrant right subclavian artery: incidence and correlation with other markers of Down syndrome in second-trimester fetuses. Ultrasound Obstet Gynecol. 2012; 39(2): 191–195.
- Sagi-Dain L, Singer A, Josefsberg S, et al. Microarray analysis has no additional value in fetal aberrant right subclavian artery: description of 268 pregnancies and systematic literature review. Ultrasound Obstet Gynecol. 2019; 53(6): 810–815.
- Musilova I, Hornychova H, Kostal M, et al. Ultrasound measurement of the transverse diameter of the fetal thymus in pregnancies complicated by the preterm prelabor rupture of membranes. J Clin Ultrasound. 2013; 41(5): 283–289.
- Cromi A, Ghezzi F, Raffaelli R, et al. Ultrasonographic measurement of thymus size in IUGR fetuses: a marker of the fetal immunoendocrine response to malnutrition. Ultrasound Obstet Gynecol. 2009; 33(4): 421–426.
- Karl K, Heling KS, Lopez AS, et al. Thymic-thoracic ratio in fetuses with trisomy 21, 18 or 13. Ultrasound Obstet Gynecol. 2012; 40(4): 412–417.
