{"id":5032,"date":"2025-02-25T08:40:17","date_gmt":"2025-02-25T08:40:17","guid":{"rendered":"https:\/\/echonews.fr\/?page_id=5032"},"modified":"2025-02-26T13:04:30","modified_gmt":"2025-02-26T13:04:30","slug":"ai-thorax-foetal","status":"publish","type":"page","link":"http:\/\/echonews.fr\/?page_id=5032","title":{"rendered":"AI-Thorax-Foetal"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"5032\" class=\"elementor elementor-5032\" data-elementor-settings=\"{&quot;ha_cmc_init_switcher&quot;:&quot;no&quot;}\">\n\t\t\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-a664abd elementor-section-full_width elementor-section-stretched elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"a664abd\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-4e5d8aa\" data-id=\"4e5d8aa\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8e2bac8 elementor-hidden-mobile elementor-widget elementor-widget-image\" data-id=\"8e2bac8\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"2560\" height=\"1106\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Bandeau-accueil-cours-thorax.jpg\" class=\"attachment-full size-full wp-image-5034\" alt=\"\" srcset=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Bandeau-accueil-cours-thorax.jpg 2560w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Bandeau-accueil-cours-thorax-300x130.jpg 300w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Bandeau-accueil-cours-thorax-1024x442.jpg 1024w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Bandeau-accueil-cours-thorax-768x332.jpg 768w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Bandeau-accueil-cours-thorax-1536x664.jpg 1536w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Bandeau-accueil-cours-thorax-2048x885.jpg 2048w\" sizes=\"(max-width: 2560px) 100vw, 2560px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-e83836e elementor-section-full_width elementor-section-stretched elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"e83836e\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-3a73111\" data-id=\"3a73111\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8facf2b elementor-hidden-desktop elementor-hidden-tablet elementor-widget elementor-widget-image\" data-id=\"8facf2b\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"1475\" height=\"1106\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Bandeau-accueil-cours-thorax-SMART.jpg\" class=\"attachment-full size-full wp-image-5035\" alt=\"\" srcset=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Bandeau-accueil-cours-thorax-SMART.jpg 1475w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Bandeau-accueil-cours-thorax-SMART-300x225.jpg 300w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Bandeau-accueil-cours-thorax-SMART-1024x768.jpg 1024w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Bandeau-accueil-cours-thorax-SMART-768x576.jpg 768w\" sizes=\"(max-width: 1475px) 100vw, 1475px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-6b83863 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"6b83863\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-ef411df\" data-id=\"ef411df\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8d1de42 elementor-widget elementor-widget-text-editor\" data-id=\"8d1de42\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: center;\"><strong>\u00c9chographie du thorax f\u0153tal : De l&#8217;anatomie normale aux malformations complexes<\/strong><\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-0aa1f3b elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"0aa1f3b\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-720e8c4\" data-id=\"720e8c4\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-bf3b898 elementor-widget-mobile__width-initial elementor-widget elementor-widget-text-editor\" data-id=\"bf3b898\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Demo<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-77a78f7\" data-id=\"77a78f7\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4e189f0 elementor-widget-mobile__width-initial elementor-widget elementor-widget-image\" data-id=\"4e189f0\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"1024\" height=\"596\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/logodef00_2@3x-1024x596.png\" class=\"attachment-large size-large wp-image-3862\" alt=\"\" srcset=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/logodef00_2@3x-1024x596.png 1024w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/logodef00_2@3x-300x175.png 300w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/logodef00_2@3x-768x447.png 768w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/01\/logodef00_2@3x.png 1485w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-c13c23f\" data-id=\"c13c23f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a871fa4 elementor-widget elementor-widget-text-editor\" data-id=\"a871fa4\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Demo<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-87f5c24 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"87f5c24\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-ef9d279\" data-id=\"ef9d279\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-b06955b\" data-id=\"b06955b\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b2bb23d elementor-view-default elementor-widget elementor-widget-icon\" data-id=\"b2bb23d\" data-element_type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<a class=\"elementor-icon\" href=\"mailto:joseph.bonan@gmail.com\">\n\t\t\t<i aria-hidden=\"true\" class=\"hm hm-mail-open\"><\/i>\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-6d5ca2d\" data-id=\"6d5ca2d\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-cabe2a2 elementor-view-default elementor-widget elementor-widget-icon\" data-id=\"cabe2a2\" data-element_type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<a class=\"elementor-icon\" href=\"https:\/\/x.com\/Jkbjkb1\">\n\t\t\t<i aria-hidden=\"true\" class=\"fab fa-x-twitter\"><\/i>\t\t\t<\/a>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-25 elementor-top-column elementor-element elementor-element-c83b42d\" data-id=\"c83b42d\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-3fb7950 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"3fb7950\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-b6c73bc\" data-id=\"b6c73bc\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8e66620 elementor-widget elementor-widget-image\" data-id=\"8e66620\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"995\" height=\"995\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/GG1-ident.decou-V2.jpg\" class=\"attachment-large size-large wp-image-5042\" alt=\"\" srcset=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/GG1-ident.decou-V2.jpg 995w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/GG1-ident.decou-V2-300x300.jpg 300w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/GG1-ident.decou-V2-150x150.jpg 150w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/GG1-ident.decou-V2-768x768.jpg 768w\" sizes=\"(max-width: 995px) 100vw, 995px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7de1028 elementor-widget elementor-widget-text-editor\" data-id=\"7de1028\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Dr Pierre Dupont<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ccfca07 elementor-shape-rounded elementor-grid-0 e-grid-align-center elementor-widget elementor-widget-social-icons\" data-id=\"ccfca07\" data-element_type=\"widget\" data-widget_type=\"social-icons.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-social-icons-wrapper elementor-grid\">\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-hm-envelop elementor-repeater-item-8ef4679\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Hm-envelop<\/span>\n\t\t\t\t\t\t<i class=\"hm hm-envelop\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-linkedin elementor-repeater-item-22d535c\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Linkedin<\/span>\n\t\t\t\t\t\t<i class=\"fab fa-linkedin\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-x-twitter elementor-repeater-item-e1d7e7f\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">X-twitter<\/span>\n\t\t\t\t\t\t<i class=\"fab fa-x-twitter\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-ae5fc23\" data-id=\"ae5fc23\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3d0fa4b elementor-widget elementor-widget-image\" data-id=\"3d0fa4b\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"1024\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/PNoble-iden-enhanced-1024x1024.png\" class=\"attachment-large size-large wp-image-5043\" alt=\"\" srcset=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/PNoble-iden-enhanced-1024x1024.png 1024w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/PNoble-iden-enhanced-300x300.png 300w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/PNoble-iden-enhanced-150x150.png 150w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/PNoble-iden-enhanced-768x768.png 768w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/PNoble-iden-enhanced-1536x1536.png 1536w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/PNoble-iden-enhanced.png 1984w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-63cf5de elementor-widget elementor-widget-text-editor\" data-id=\"63cf5de\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Dr Margaret Smith<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ed04f16 elementor-shape-rounded elementor-grid-0 e-grid-align-center elementor-widget elementor-widget-social-icons\" data-id=\"ed04f16\" data-element_type=\"widget\" data-widget_type=\"social-icons.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-social-icons-wrapper elementor-grid\">\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-hm-envelop elementor-repeater-item-8ef4679\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Hm-envelop<\/span>\n\t\t\t\t\t\t<i class=\"hm hm-envelop\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-linkedin elementor-repeater-item-33f156f\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Linkedin<\/span>\n\t\t\t\t\t\t<i class=\"fab fa-linkedin\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-33 elementor-top-column elementor-element elementor-element-b79d567\" data-id=\"b79d567\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f2b7e75 elementor-widget elementor-widget-image\" data-id=\"f2b7e75\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"1024\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/sananes1-ident-decou-enhanced-V2-1024x1024.jpg\" class=\"attachment-large size-large wp-image-5044\" alt=\"\" srcset=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/sananes1-ident-decou-enhanced-V2-1024x1024.jpg 1024w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/sananes1-ident-decou-enhanced-V2-300x300.jpg 300w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/sananes1-ident-decou-enhanced-V2-150x150.jpg 150w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/sananes1-ident-decou-enhanced-V2-768x768.jpg 768w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/sananes1-ident-decou-enhanced-V2-1536x1536.jpg 1536w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/sananes1-ident-decou-enhanced-V2.jpg 1984w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d06c5d2 elementor-widget elementor-widget-text-editor\" data-id=\"d06c5d2\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Dr Fran\u00e7ois durand<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c0e54bc elementor-shape-rounded elementor-grid-0 e-grid-align-center elementor-widget elementor-widget-social-icons\" data-id=\"c0e54bc\" data-element_type=\"widget\" data-widget_type=\"social-icons.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-social-icons-wrapper elementor-grid\">\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-hm-envelop elementor-repeater-item-8ef4679\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Hm-envelop<\/span>\n\t\t\t\t\t\t<i class=\"hm hm-envelop\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-youtube elementor-repeater-item-c3ba047\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Youtube<\/span>\n\t\t\t\t\t\t<i class=\"fab fa-youtube\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t\t\t<span class=\"elementor-grid-item\">\n\t\t\t\t\t<a class=\"elementor-icon elementor-social-icon elementor-social-icon-linkedin elementor-repeater-item-b144531\" target=\"_blank\">\n\t\t\t\t\t\t<span class=\"elementor-screen-only\">Linkedin<\/span>\n\t\t\t\t\t\t<i class=\"fab fa-linkedin\"><\/i>\t\t\t\t\t<\/a>\n\t\t\t\t<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-c80a116 elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"c80a116\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-958db6c\" data-id=\"958db6c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1d53588 elementor-widget elementor-widget-text-editor\" data-id=\"1d53588\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: justify;\">Ce cours, d\u2019une dur\u00e9e de deux heures, vise \u00e0 fournir aux participants une approche compl\u00e8te et structur\u00e9e de l\u2019\u00e9chographie du thorax f\u0153tal, allant de l\u2019anatomie normale aux malformations les plus complexes.<\/p><p style=\"text-align: justify;\">Dans un premier temps, nous aborderons les bases de l\u2019\u00e9chographie thoracique, en d\u00e9taillant les techniques d\u2019imagerie utilis\u00e9es, les coupes \u00e9chographiques essentielles et les crit\u00e8res d\u2019\u00e9valuation des structures thoraciques normales. Cette compr\u00e9hension de l\u2019anatomie normale est indispensable pour identifier toute anomalie et en \u00e9valuer la s\u00e9v\u00e9rit\u00e9.<\/p><p style=\"text-align: justify;\">Nous explorerons ensuite les principales malformations cong\u00e9nitales, notamment la <strong>hernie diaphragmatique cong\u00e9nitale (HDC)<\/strong> et les <strong>malformations pulmonaires cong\u00e9nitales<\/strong> telles que la <strong>maladie ad\u00e9nomato\u00efde kystique pulmonaire (MAKP)<\/strong> et la <strong>s\u00e9questration pulmonaire<\/strong>.<\/p><p style=\"text-align: justify;\">L\u2019accent sera mis sur les signes \u00e9chographiques distinctifs, les outils pronostiques comme le <strong>Lung-to-Head Ratio (LHR)<\/strong> et les options th\u00e9rapeutiques disponibles, y compris les interventions pr\u00e9natales comme l\u2019<strong>occlusion trach\u00e9ale f\u0153toscopique (FETO)<\/strong>.<\/p><p style=\"text-align: justify;\">D\u2019autres pathologies thoraciques, comme les \u00e9panchements pleuraux, les masses m\u00e9diastinales et les anomalies du diaphragme, seront \u00e9galement abord\u00e9es.<\/p><p style=\"text-align: justify;\">Enfin, nous discuterons des implications cliniques et de la prise en charge multidisciplinaire, en mettant l\u2019accent sur la surveillance \u00e9chographique, les d\u00e9cisions obst\u00e9tricales, la r\u00e9animation n\u00e9onatale et les interventions postnatales.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-839d9d3 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"839d9d3\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-715405e\" data-id=\"715405e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e7416a2 elementor-widget elementor-widget-text-editor\" data-id=\"e7416a2\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: justify;\">Plan du cours<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bb18985 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"bb18985\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-1fc8c9c elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"1fc8c9c\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-29d4c3e\" data-id=\"29d4c3e\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5672b97 elementor-widget elementor-widget-toggle\" data-id=\"5672b97\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-9061\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-9061\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">1. Introduction \u00e0 l\u2019\u00e9chographie du thorax f\u0153tal (10 min)<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-9061\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-9061\"><ul><li>Pr\u00e9sentation des objectifs du cours<\/li><li>Importance de l\u2019\u00e9chographie pour l\u2019\u00e9tude du thorax f\u0153tal<\/li><li>Techniques et principes de base de l\u2019\u00e9chographie thoracique f\u0153tale<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-9062\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-9062\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">2. Anatomie normale du thorax f\u0153tal (15 min)<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-9062\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-9062\"><ul><li>Structures principales \u00e0 analyser en \u00e9chographie :<ul><li>Poumons<\/li><li>Diaphragme<\/li><li>C\u0153ur et m\u00e9diastin<\/li><li>Cage thoracique et c\u00f4tes<\/li><\/ul><\/li><li>Coupes \u00e9chographiques essentielles :<ul><li>Axiale<\/li><li>Parasagittale<\/li><\/ul><\/li><li>Signes \u00e9chographiques d\u2019un d\u00e9veloppement pulmonaire normal<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-9063\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-9063\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">3. Techniques et strat\u00e9gies d\u2019\u00e9valuation \u00e9chographique (15 min)<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-9063\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-9063\"><ul><li>Techniques d\u2019imagerie :<ul><li>Mode 2D<\/li><li>Doppler couleur<\/li><li>Mode 3D (si applicable)<\/li><\/ul><\/li><li>Importance des mesures quantitatives :<ul><li>Lung-to-Head Ratio (LHR)<\/li><li>Volume pulmonaire mesur\u00e9 en IRM<\/li><\/ul><\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-9064\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-9064\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">4. Malformations cong\u00e9nitales du thorax f\u0153tal (30 min)<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-9064\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-9064\"><p><strong>4.1. Hernie diaphragmatique cong\u00e9nitale (HCD) (15 min)<\/strong><\/p><ul><li>Physiopathologie et incidence<\/li><li>Signes \u00e9chographiques :<ul><li>D\u00e9placement du c\u0153ur<\/li><li>Position anormale de l\u2019estomac et du foie<\/li><\/ul><\/li><li>Outils pronostiques :<ul><li>LHR observ\u00e9\/attendu<\/li><li>Position du foie et de l\u2019estomac<\/li><\/ul><\/li><\/ul><p><strong>4.2. Malformations pulmonaires cong\u00e9nitales (15 min)<\/strong><\/p><ul><li>Maladie ad\u00e9nomato\u00efde kystique pulmonaire (MAKP)<\/li><li>S\u00e9questration pulmonaire<\/li><li>Atr\u00e9sie bronchique<\/li><li>Imagerie et diff\u00e9renciation \u00e9chographique<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-9ed176a\" data-id=\"9ed176a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-130535d elementor-widget elementor-widget-toggle\" data-id=\"130535d\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1991\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-1991\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">5. Autres pathologies thoraciques f\u0153tales (20 min)<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1991\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-1991\"><ul><li>Chylothorax cong\u00e9nital<\/li><li>Effusions pleurales<\/li><li>Masses m\u00e9diastinales (kystes bronchog\u00e9niques, t\u00e9ratomes)<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1992\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-1992\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">6. Implications cliniques et prise en charge (20 min)<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1992\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-1992\"><ul><li>Importance du diagnostic pr\u00e9natal<\/li><li>Surveillance \u00e9chographique des cas \u00e0 risque<\/li><li>Approche multidisciplinaire et implications obst\u00e9tricales<\/li><li>Options th\u00e9rapeutiques in utero (ex. occlusion trach\u00e9ale pour HCD)<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1993\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-1993\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">7. Conclusion et discussion (10 min)<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1993\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-1993\"><ul><li>Synth\u00e8se des points cl\u00e9s du cours<\/li><li>Perspectives futures et d\u00e9veloppement des techniques d\u2019imagerie<\/li><li>Questions et \u00e9changes avec les participants<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-daf30f8 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"daf30f8\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-5526ac6\" data-id=\"5526ac6\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e5a47ed elementor-widget elementor-widget-text-editor\" data-id=\"e5a47ed\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: left;\">d\u00e9veloppement des chapitres du plan<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d07826c elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"d07826c\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-28eea8a elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"28eea8a\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-d3d3540\" data-id=\"d3d3540\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f0fc161 elementor-widget elementor-widget-toggle\" data-id=\"f0fc161\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2521\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-2521\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Chapitre 1 : Introduction \u00e0 l\u2019\u00e9chographie du thorax f\u0153tal<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2521\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-2521\"><p><strong>1.1. Objectifs du chapitre (2 min)<\/strong><\/p><ul><li>Comprendre l\u2019int\u00e9r\u00eat de l\u2019\u00e9chographie dans l\u2019\u00e9valuation du thorax f\u0153tal<\/li><li>Identifier les indications principales de l\u2019examen<\/li><li>Appr\u00e9hender les limites et les d\u00e9fis diagnostiques<\/li><\/ul><p><strong>1.2. Importance de l\u2019\u00e9chographie thoracique<\/strong> <strong>f\u0153tale en m\u00e9decine pr\u00e9natale (3 min)<\/strong><\/p><ul><li><strong>R\u00f4le cl\u00e9 du diagnostic pr\u00e9natal<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>D\u00e9tection des anomalies pulmonaires et diaphragmatique<\/li><li>Anticipation des complications n\u00e9onatales<\/li><li>Planification de la prise en charge obst\u00e9tricale et postnatale<\/li><\/ul><\/li><\/ul><ul><li><strong>Comparaison avec d&#8217;autres techniques d\u2019imagerie<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>IRM f\u0153tale : compl\u00e9mentaire \u00e0 l\u2019\u00e9chographie pour le calcul du volume pulmonaire<\/li><li>Radiographie et scanner postnatals : non r\u00e9alisables in utero, mais essentiels apr\u00e8s la naissance<\/li><\/ul><\/li><\/ul><ul><li><strong>Indications principales de l\u2019\u00e9chographie thoracique f\u0153tale<\/strong><\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Suspicion de malformation pulmonaire (ex. hernie diaphragmatique cong\u00e9nitale, s\u00e9questration pulmonaire)<\/li><li>Anomalie d\u00e9tect\u00e9e lors de l\u2019\u00e9chographie morphologique syst\u00e9matique<\/li><li>Signes d\u2019hydrops f\u0153tal ou d\u2019\u00e9panchement pleural<\/li><\/ul><\/li><\/ul><p><strong>1.3. Techniques et principes de base de l\u2019\u00e9chographie thoracique f\u0153tale (5 min)<\/strong><\/p><p><strong>1.3.1. Modes d\u2019imagerie utilis\u00e9s<\/strong><\/p><ul><li><strong>Mode 2D (B-mode)<\/strong> :<\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Identification des structures thoraciques normales<\/li><li>D\u00e9tection des masses ou des anomalies du diaphragme<\/li><\/ul><\/li><\/ul><ul><li><strong>Doppler couleur et Doppler puls\u00e9<\/strong> :<\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Analyse des flux sanguins dans les vaisseaux pulmonaires et le c\u0153ur<\/li><li>Identification d\u2019un \u00e9ventuel shunt vasculaire (ex. s\u00e9questration pulmonaire)<\/li><\/ul><\/li><\/ul><ul><li><strong>Mode 3D\/4D (si disponible)<\/strong> :<\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Reconstruction volumique des poumons<\/li><li>Am\u00e9lioration de la visualisation des structures m\u00e9diastinales<\/li><\/ul><\/li><\/ul><p><strong>1.3.2. Coupes \u00e9chographiques essentielles<\/strong><\/p><ul><li><strong>Coupe axiale standard (transversale)<\/strong> :<\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Vue de r\u00e9f\u00e9rence pour \u00e9valuer les poumons et le c\u0153ur<\/li><li>Identification de l\u2019estomac et du foie en cas de suspicion de hernie diaphragmatique<\/li><\/ul><\/li><\/ul><ul><li><strong>Coupes longitudinales parasagittales<\/strong> :<\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>\u00c9valuation de la continuit\u00e9 du diaphragme<\/li><li>V\u00e9rification de l\u2019emplacement des organes abdominaux<\/li><\/ul><\/li><\/ul><ul><li><strong>Coupes coronalement orient\u00e9es<\/strong> :<\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Appr\u00e9ciation de la sym\u00e9trie pulmonaire<\/li><li>D\u00e9tection des \u00e9panchements pleuraux<\/li><\/ul><\/li><\/ul><p><strong>1.3.3. Rep\u00e8res anatomiques cl\u00e9s en \u00e9chographie thoracique f\u0153tale<\/strong><\/p><ul><li><strong>Le c\u0153ur et son positionnement<\/strong> : \u00e9valuation du situs et du d\u00e9placement \u00e9ventuel<\/li><li><strong>Le diaphragme<\/strong> : pr\u00e9sence, continuit\u00e9 et concavit\u00e9<\/li><li><strong>Les poumons<\/strong> : homog\u00e9n\u00e9it\u00e9, volume et vascularisation<\/li><li><strong>Le m\u00e9diastin<\/strong> : d\u00e9viation, compression des structures environnantes<\/li><\/ul><p><strong>1.4. Limites et d\u00e9fis diagnostiques (2 min)<\/strong><\/p><ul><li><strong>Facteurs influen\u00e7ant la qualit\u00e9 de l\u2019image \u00e9chographique<\/strong> :<\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Position f\u0153tale d\u00e9favorable<\/li><li>Oligohydramnios r\u00e9duisant la fen\u00eatre acoustique<\/li><li>Ob\u00e9sit\u00e9 maternelle compliquant la transmission des ultrasons<\/li><\/ul><\/li><\/ul><ul><li><strong>Probl\u00e8mes d\u2019interpr\u00e9tation possibles<\/strong> :<\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Confusion entre certaines malformations (ex. s\u00e9questration pulmonaire vs. maladie ad\u00e9nomato\u00efde kystique pulmonaire)<\/li><li>Estimation difficile du pronostic en cas de l\u00e9sions complexes<\/li><\/ul><\/li><\/ul><ul><li><strong>Compl\u00e9mentarit\u00e9 avec l\u2019IRM f\u0153tale<\/strong> :<\/li><\/ul><ul><li style=\"list-style-type: none;\"><ul><li>Pr\u00e9cision accrue pour le volume pulmonaire et la diff\u00e9renciation tissulaire<\/li><li>Meilleure \u00e9valuation des structures m\u00e9diastinales<\/li><\/ul><\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2522\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-2522\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Chapitre 2 : Anatomie normale du thorax f\u0153tal <\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2522\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-2522\"><p><strong><em>2.1. Introduction et objectifs du chapitre (2 min)<\/em><\/strong><\/p><ul><li>Comprendre l\u2019organisation anatomique du thorax f\u0153tal<\/li><li>Apprendre \u00e0 identifier les structures thoraciques normales en \u00e9chographie<\/li><li>Savoir diff\u00e9rencier un d\u00e9veloppement pulmonaire normal d\u2019un d\u00e9veloppement pathologique<\/li><\/ul><p><strong><em>2.2. Structures principales \u00e0 analyser en \u00e9chographie thoracique f\u0153tale (5 min)<\/em><\/strong><\/p><p><strong>2.2.1. Poumons f\u0153taux<\/strong><\/p><ul><li>D\u00e9veloppement embryologique et phases de maturation :<ul><li>Phase pseudoglandulaire (5-17 SA)<\/li><li>Phase canaliculaire (16-26 SA)<\/li><li>Phase sacculaire (24-36 SA)<\/li><li>Phase alv\u00e9olaire (\u00e0 partir de 36 SA)<\/li><\/ul><\/li><li><strong>Aspect \u00e9chographique normal<\/strong> :<ul><li>\u00c9chog\u00e9nicit\u00e9 homog\u00e8ne au 2e trimestre<\/li><li>Augmentation progressive de l\u2019\u00e9chog\u00e9nicit\u00e9 au 3e trimestre<\/li><li>Sym\u00e9trie des poumons droit et gauche<\/li><\/ul><\/li><\/ul><p><strong>2.2.2. Diaphragme<\/strong><\/p><ul><li>Structure musculo-tendineuse s\u00e9parant le thorax et l\u2019abdomen<\/li><li><strong>Crit\u00e8res \u00e9chographiques d\u2019un diaphragme normal<\/strong> :<ul><li>Ligne hyper\u00e9chog\u00e8ne continue<\/li><li>Concavit\u00e9 dirig\u00e9e vers l\u2019abdomen<\/li><li>Absence de solution de continuit\u00e9<\/li><\/ul><\/li><\/ul><p><strong>2.2.3. C\u0153ur et m\u00e9diastin<\/strong><\/p><ul><li>\u00c9valuation du <strong>positionnement cardiaque<\/strong> :<ul><li>C\u0153ur situ\u00e9 \u00e0 gauche<\/li><li>Apex dirig\u00e9 \u00e0 45\u00b0 vers la gauche<\/li><\/ul><\/li><li>Structures m\u00e9diastinales visibles :<ul><li>Thymus : aspect homog\u00e8ne et l\u00e9g\u00e8rement hyperechog\u00e8ne<\/li><li>Art\u00e8re pulmonaire et aorte thoracique<\/li><\/ul><\/li><\/ul><p><strong>2.2.4. Cage thoracique et c\u00f4tes<\/strong><\/p><ul><li>Forme ovo\u00efde du thorax<\/li><li>D\u00e9veloppement harmonieux des c\u00f4tes<\/li><li>R\u00f4le protecteur et indicateur du bon d\u00e9veloppement pulmonaire<\/li><\/ul><p><strong><em>2.3. Coupes \u00e9chographiques essentielles pour l\u2019\u00e9tude du thorax f\u0153tal (5 min)<\/em><\/strong><\/p><p><strong>2.3.1. Coupe axiale standard (transversale)<\/strong><\/p><ul><li>Vue de r\u00e9f\u00e9rence pour l\u2019analyse du thorax<\/li><li>Structures visualis\u00e9es :<ul><li>Poumons sym\u00e9triques<\/li><li>C\u0153ur et sa position<\/li><li>\u00c9l\u00e9ments du m\u00e9diastin (thymus, gros vaisseaux)<\/li><\/ul><\/li><\/ul><p><strong>2.3.2. Coupe longitudinale parasagittale<\/strong><\/p><ul><li>Permet d\u2019examiner :<ul><li>La continuit\u00e9 du diaphragme<\/li><li>L\u2019int\u00e9grit\u00e9 des poumons et leur rapport avec l\u2019abdomen<\/li><\/ul><\/li><\/ul><p><strong>2.3.3. Coupe coronale<\/strong><\/p><ul><li>Int\u00e9r\u00eat dans l\u2019\u00e9valuation des \u00e9panchements pleuraux<\/li><li>Permet d\u2019observer la sym\u00e9trie des poumons<\/li><\/ul><p><strong><em>2.4. Signes \u00e9chographiques d\u2019un d\u00e9veloppement pulmonaire normal (3 min)<\/em><\/strong><\/p><ul><li><strong>\u00c9valuation du volume pulmonaire<\/strong> :<ul><li>Poumons occupent environ <strong>1\/3 de la cavit\u00e9 thoracique<\/strong><\/li><li>Absence de compression ou de d\u00e9placement m\u00e9diastinal<\/li><\/ul><\/li><li><strong>Lung-to-Head Ratio (LHR)<\/strong> :<ul><li>Utilis\u00e9 pour \u00e9valuer les cas de hernie diaphragmatique cong\u00e9nitale<\/li><li>LHR normal &gt; 1.0<\/li><\/ul><\/li><li><strong>Doppler des art\u00e8res pulmonaires<\/strong> :<ul><li>D\u00e9bit sanguin homog\u00e8ne et sym\u00e9trique<\/li><\/ul><\/li><\/ul><p><strong><em>2.5. Conclusion et transition vers le chapitre suivant (1 min)<\/em><\/strong><\/p><ul><li>Importance de conna\u00eetre l\u2019anatomie normale pour d\u00e9tecter les anomalies<\/li><li>Transition vers les techniques d\u2019\u00e9valuation avanc\u00e9es pour affiner le diagnostic \u00e9chographique<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2523\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-2523\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Chapitre 3 : Techniques et strat\u00e9gies d\u2019\u00e9valuation \u00e9chographique du thorax f\u0153tal <\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2523\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-2523\"><p><strong><em>3.1. Introduction et objectifs du chapitre (2 min)<\/em><\/strong><\/p><ul><li>Comprendre les diff\u00e9rentes techniques d\u2019imagerie \u00e9chographique appliqu\u00e9es au thorax f\u0153tal<\/li><li>Savoir adapter la m\u00e9thode d\u2019\u00e9valuation en fonction du contexte clinique<\/li><li>Identifier les outils permettant d\u2019affiner le diagnostic<\/li><\/ul><p><strong><em>3.2. Modes d\u2019imagerie utilis\u00e9s en \u00e9chographie thoracique f\u0153tale (6 min)<\/em><\/strong><\/p><p><strong>3.2.1. Mode 2D (B-mode) : analyse morphologique de base (2 min)<\/strong><\/p><ul><li>Mode principal pour l\u2019\u00e9valuation du thorax<\/li><li>Permet d\u2019\u00e9valuer :<ul><li>La sym\u00e9trie pulmonaire<\/li><li>La position et la taille du c\u0153ur<\/li><li>La continuit\u00e9 et la concavit\u00e9 du diaphragme<\/li><li>L\u2019existence d\u2019\u00e9panchements pleuraux ou d\u2019images anormales<\/li><\/ul><\/li><li><strong>Points d\u2019attention :<\/strong><ul><li>Qualit\u00e9 de l\u2019image influenc\u00e9e par la position f\u0153tale et la quantit\u00e9 de liquide amniotique<\/li><li>Limites en cas d\u2019oligohydramnios<\/li><\/ul><\/li><\/ul><p><strong>3.2.2. Doppler couleur et Doppler puls\u00e9 : analyse vasculaire (2 min)<\/strong><\/p><ul><li>Identification des flux sanguins :<ul><li><strong>Vascularisation pulmonaire<\/strong> : art\u00e8res et veines pulmonaires<\/li><li><strong>C\u0153ur et gros vaisseaux<\/strong> : \u00e9valuation des connections normales et des shunts anormaux<\/li><li><strong>D\u00e9tection d\u2019une s\u00e9questration pulmonaire<\/strong> par mise en \u00e9vidence d\u2019une art\u00e8re syst\u00e9mique anormale<\/li><\/ul><\/li><li><strong>Param\u00e8tres \u00e9valu\u00e9s en Doppler puls\u00e9<\/strong> :<ul><li>Indice de r\u00e9sistance des art\u00e8res pulmonaires<\/li><li>Flux dans la veine cave inf\u00e9rieure et le canal veineux pour \u00e9valuer une \u00e9ventuelle insuffisance cardiaque<\/li><\/ul><\/li><\/ul><p><strong>3.2.3. Mode 3D\/4D : application avanc\u00e9e (2 min)<\/strong><\/p><ul><li><strong>Utilisation en compl\u00e9ment du mode 2D pour :<\/strong><ul><li>Reconstruction volumique des poumons<\/li><li>Analyse d\u00e9taill\u00e9e des structures m\u00e9diastinales<\/li><li>Diff\u00e9renciation entre l\u00e9sions kystiques et solides<\/li><\/ul><\/li><li><strong>Avantages :<\/strong><ul><li>Am\u00e9lioration de la visualisation des structures complexes<\/li><li>Permet une \u00e9valuation plus pr\u00e9cise de l\u2019hypoplasie pulmonaire<\/li><\/ul><\/li><\/ul><p><strong><em>3.3. Coupes \u00e9chographiques essentielles pour l\u2019\u00e9valuation thoracique (4 min)<\/em><\/strong><\/p><p><strong>3.3.1. Coupe axiale standard (2 min)<\/strong><\/p><ul><li>Vue de r\u00e9f\u00e9rence pour l\u2019analyse thoracique<\/li><li>Structures visibles :<ul><li><strong>Poumons sym\u00e9triques<\/strong> : homog\u00e9n\u00e9it\u00e9 de l\u2019\u00e9chog\u00e9nicit\u00e9<\/li><li><strong>C\u0153ur<\/strong> : position normale avec apex pointant \u00e0 gauche<\/li><li><strong>Diaphragme<\/strong> : continuit\u00e9 et concavit\u00e9<\/li><\/ul><\/li><li><strong>Applications diagnostiques :<\/strong><ul><li>D\u00e9tection d\u2019une <strong>hernie diaphragmatique cong\u00e9nitale<\/strong><\/li><li>Identification de <strong>l\u00e9sions pulmonaires kystiques ou solides<\/strong><\/li><\/ul><\/li><\/ul><p><strong>3.3.2. Coupe longitudinale parasagittale (1 min)<\/strong><\/p><ul><li>Int\u00e9r\u00eat pour l\u2019\u00e9tude du <strong>diaphragme<\/strong><\/li><li>V\u00e9rification du <strong>contenu abdominal et de sa position<\/strong><\/li><li>Utilis\u00e9e en cas de <strong>suspicion de hernie diaphragmatique<\/strong><\/li><\/ul><p><strong>3.3.3. Coupe coronale (1 min)<\/strong><\/p><ul><li>Permet d\u2019\u00e9valuer la sym\u00e9trie thoracique<\/li><li>D\u00e9tection des <strong>\u00e9panchements pleuraux et anomalies m\u00e9diastinales<\/strong><\/li><\/ul><p><strong>3.4. Importance des mesures quantitatives (3 min)<\/strong><\/p><p><strong>3.4.1. Lung-to-Head Ratio (LHR)<\/strong><\/p><ul><li>Calcul\u00e9 en cas de suspicion de <strong>hernie diaphragmatique cong\u00e9nitale<\/strong><\/li><li>LHR = Surface pulmonaire controlat\u00e9rale \/ P\u00e9rim\u00e8tre c\u00e9phalique<\/li><li>Valeurs seuils :<ul><li><strong>LHR &gt; 1.0 : bon pronostic<\/strong><\/li><li><strong>LHR &lt; 1.0 : risque accru d\u2019hypoplasie pulmonaire<\/strong><\/li><\/ul><\/li><\/ul><p><strong>3.4.2. Volume pulmonaire mesur\u00e9 en IRM<\/strong><\/p><ul><li>Utilis\u00e9 pour affiner l\u2019\u00e9valuation de l\u2019hypoplasie pulmonaire<\/li><li>Observed-to-Expected Total Fetal Lung Volume (O\/E-TFLV)<\/li><li>Meilleur pr\u00e9dicteur du pronostic n\u00e9onatal en cas de malformations pulmonaires<\/li><\/ul><p><strong>3.4.3. \u00c9valuation du rapport thorax-abdomen<\/strong><\/p><ul><li>Un rapport thoracique trop r\u00e9duit peut indiquer une hypoplasie pulmonaire s\u00e9v\u00e8re<\/li><\/ul><p><strong><em>3.5. Conclusion et transition vers le chapitre suivant (1 min)<\/em><\/strong><\/p><ul><li>Importance d\u2019une approche multimodale (2D, Doppler, 3D) pour un diagnostic optimal<\/li><li>Transition vers <strong>l\u2019\u00e9valuation des malformations thoraciques cong\u00e9nitales<\/strong><\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-7446faa\" data-id=\"7446faa\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7046b1e elementor-widget elementor-widget-toggle\" data-id=\"7046b1e\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1171\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-1171\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Chapitre 4 : Malformations cong\u00e9nitales du thorax f\u0153tal <\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1171\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-1171\"><p><strong><em>4.1. Introduction et objectifs du chapitre (2 min)<\/em><\/strong><\/p><ul><li>D\u00e9finir les principales malformations thoraciques cong\u00e9nitales d\u00e9tectables en \u00e9chographie<\/li><li>Comprendre l\u2019impact de ces malformations sur la croissance pulmonaire et la survie n\u00e9onatale<\/li><li>Identifier les crit\u00e8res \u00e9chographiques permettant de diff\u00e9rencier ces anomalies<\/li><\/ul><p><strong><em>4.2. Hernie diaphragmatique cong\u00e9nitale (HDC) (15 min)<\/em><\/strong><\/p><p><strong>4.2.1. D\u00e9finition et physiopathologie (2 min)<\/strong><\/p><ul><li>D\u00e9faut de fermeture du diaphragme entra\u00eenant la migration des organes abdominaux dans le thorax<\/li><li>Incidence : 1\/3 500 naissances<\/li><li>Types de HDC :<ul><li><strong>Hernie de Bochdalek (95%)<\/strong> : post\u00e9ro-lat\u00e9rale gauche<\/li><li><strong>Hernie de Morgagni (5%)<\/strong> : ant\u00e9rieure droite<\/li><\/ul><\/li><\/ul><p><strong>4.2.2. Signes \u00e9chographiques de la HDC (4 min)<\/strong><\/p><ul><li><strong>D\u00e9placement du c\u0153ur vers le c\u00f4t\u00e9 oppos\u00e9<\/strong><\/li><li><strong>Absence de visualisation de la coupole diaphragmatique<\/strong><\/li><li><strong>Pr\u00e9sence d\u2019organes abdominaux dans le thorax<\/strong> :<ul><li><strong>Estomac intrathoracique<\/strong> (HDC gauche)<\/li><li><strong>Foie intrathoracique<\/strong> (HDC droite)<\/li><\/ul><\/li><li><strong>Hydramnios associ\u00e9<\/strong> (en raison de la compression de l\u2019\u0153sophage)<\/li><\/ul><p><strong>4.2.3. Outils pronostiques en cas de HDC (5 min)<\/strong><\/p><ol><li><strong> Lung-to-Head Ratio (LHR) : \u00e9valuation du d\u00e9veloppement pulmonaire<\/strong><\/li><\/ol><ul><li>LHR observ\u00e9\/attendu (O\/E-LHR) :<ul><li><strong>&gt;45% : bon pronostic<\/strong><\/li><li><strong>25-45% : pronostic interm\u00e9diaire<\/strong><\/li><li><strong>&lt;25% : pronostic s\u00e9v\u00e8re<\/strong><\/li><\/ul><\/li><\/ul><ol start=\"2\"><li><strong> Position du foie : facteur pr\u00e9dictif majeur<\/strong><\/li><\/ol><ul><li><strong>Foie intra-abdominal : meilleur pronostic<\/strong><\/li><li><strong>Foie intrathoracique : risque accru d\u2019hypoplasie pulmonaire<\/strong><\/li><\/ul><ol start=\"3\"><li><strong> Volume pulmonaire en IRM<\/strong><\/li><\/ol><ul><li>O\/E-TFLV (Observed-to-Expected Total Fetal Lung Volume) :<ul><li><strong>Corr\u00e9lation avec le taux de survie<\/strong><\/li><li><strong>Permet une meilleure \u00e9valuation de la gravit\u00e9 de l\u2019hypoplasie pulmonaire<\/strong><\/li><\/ul><\/li><\/ul><p><strong>4.2.4. Options th\u00e9rapeutiques et prise en charge (4 min)<\/strong><\/p><ul><li><strong>Suivi \u00e9chographique r\u00e9gulier<\/strong><\/li><li><strong>Fetoscopic Endoluminal Tracheal Occlusion (FETO) en cas de LHR tr\u00e8s bas<\/strong><\/li><li><strong>Accouchement en centre de niveau III avec \u00e9quipe sp\u00e9cialis\u00e9e en chirurgie n\u00e9onatale<\/strong><\/li><li><strong>Chirurgie postnatale apr\u00e8s stabilisation du nouveau-n\u00e9<\/strong><\/li><\/ul><p><strong><em>4.3. Malformations pulmonaires cong\u00e9nitales (15 min)<\/em><\/strong><\/p><p><strong>4.3.1. Maladie ad\u00e9nomato\u00efde kystique pulmonaire (MAKP) (5 min)<\/strong><\/p><ol><li><strong> D\u00e9finition et classification<\/strong><\/li><\/ol><ul><li>Malformation kystique due \u00e0 une prolif\u00e9ration anormale du tissu pulmonaire<\/li><li>Classification de Stocker :<ul><li><strong>Type I<\/strong> : macrokystique (\u2265 5 mm)<\/li><li><strong>Type II<\/strong> : microkystique (&lt; 5 mm)<\/li><li><strong>Type III<\/strong> : massif, \u00e9chog\u00e8ne<\/li><\/ul><\/li><\/ul><ol start=\"2\"><li><strong> Signes \u00e9chographiques<\/strong><\/li><\/ol><ul><li><strong>Masse pulmonaire hyper\u00e9chog\u00e8ne unilat\u00e9rale<\/strong><\/li><li><strong>Pr\u00e9sence de kystes (variable selon le type)<\/strong><\/li><li><strong>D\u00e9viation du m\u00e9diastin possible en cas de l\u00e9sion volumineuse<\/strong><\/li><li><strong>Hydramnios en cas de compression \u0153sophagienne<\/strong><\/li><\/ul><ol start=\"3\"><li><strong> Pronostic et prise en charge<\/strong><\/li><\/ol><ul><li><strong>R\u00e9gression spontan\u00e9e possible au 3\u1d49 trimestre<\/strong><\/li><li><strong>Chirurgie postnatale si l\u00e9sions symptomatiques ou volumineuses<\/strong><\/li><\/ul><p><strong>4.3.2. S\u00e9questration pulmonaire (5 min)<\/strong><\/p><ol><li><strong> D\u00e9finition et classification<\/strong><\/li><\/ol><ul><li>Tissu pulmonaire non fonctionnel aliment\u00e9 par une circulation syst\u00e9mique anormale<\/li><li><strong>Types :<\/strong><ul><li><strong>S\u00e9questration intralobaire<\/strong> : absence de pl\u00e8vre propre, drain\u00e9e par le syst\u00e8me pulmonaire<\/li><li><strong>S\u00e9questration extralobaire<\/strong> : pl\u00e8vre propre, drain\u00e9e par la circulation syst\u00e9mique<\/li><\/ul><\/li><\/ul><ol start=\"2\"><li><strong> Signes \u00e9chographiques<\/strong><\/li><\/ol><ul><li><strong>Masse pulmonaire hyper\u00e9chog\u00e8ne bien d\u00e9limit\u00e9e<\/strong><\/li><li><strong>Visualisation d\u2019un vaisseau anormal \u00e0 l\u2019\u00e9chographie Doppler<\/strong><\/li><li><strong>Absence de connexion avec l\u2019arbre bronchique<\/strong><\/li><\/ul><ol start=\"3\"><li><strong> Pronostic et prise en charge<\/strong><\/li><\/ol><ul><li>Surveillance pr\u00e9natale si absence de complications<\/li><li>Chirurgie postnatale si complications respiratoires<\/li><\/ul><p><strong>4.3.3. Atr\u00e9sie bronchique (5 min)<\/strong><\/p><ol><li><strong> D\u00e9finition et m\u00e9canisme<\/strong><\/li><\/ol><ul><li>Obstruction cong\u00e9nitale d\u2019une bronche proximale<\/li><li>Accumulation de liquide en aval entra\u00eenant une distension pulmonaire<\/li><\/ul><ol start=\"2\"><li><strong> Signes \u00e9chographiques<\/strong><\/li><\/ol><ul><li><strong>Masse pulmonaire hyper\u00e9chog\u00e8ne<\/strong><\/li><li><strong>Dilatation des bronchioles distales<\/strong><\/li><li><strong>D\u00e9viation du m\u00e9diastin en cas de volumineuse l\u00e9sion<\/strong><\/li><\/ul><ol start=\"3\"><li><strong> Prise en charge<\/strong><\/li><\/ol><ul><li>Surveillance pr\u00e9natale si asymptomatique<\/li><li>Chirurgie postnatale si d\u00e9tresse respiratoire<\/li><\/ul><p><strong><em>4.4. Conclusion et transition vers le chapitre suivant (2 min)<\/em><\/strong><\/p><ul><li>Importance du <strong>diagnostic diff\u00e9rentiel<\/strong> entre les malformations thoraciques<\/li><li>Lien entre <strong>imagerie pr\u00e9natale et prise en charge postnatale<\/strong><\/li><li>Transition vers le <strong>chapitre 5 : Autres pathologies thoraciques f\u0153tales<\/strong><\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1172\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-1172\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Chapitre 5 : Autres pathologies thoraciques f\u0153tales <\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1172\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-1172\"><p><strong><em>5.1. Introduction et objectifs du chapitre (2 min)<\/em><\/strong><\/p><ul><li>Identifier les pathologies thoraciques f\u0153tales autres que la hernie diaphragmatique et les malformations pulmonaires cong\u00e9nitales<\/li><li>Comprendre les signes \u00e9chographiques permettant de les diagnostiquer<\/li><li>Expliquer l\u2019impact de ces anomalies sur le d\u00e9veloppement f\u0153tal et leur prise en charge<\/li><\/ul><p><strong><em>5.2. Chylothorax cong\u00e9nital (5 min)<\/em><\/strong><\/p><p><strong>5.2.1. D\u00e9finition et physiopathologie (1 min)<\/strong><\/p><ul><li><strong>\u00c9panchement pleural lymphatique<\/strong> secondaire \u00e0 une fuite du canal thoracique<\/li><li><strong>Incidence :<\/strong> environ 1\/10 000 naissances<\/li><li><strong>Formes :<\/strong><ul><li><strong>Idiopathique (primitif)<\/strong> : anomalie isol\u00e9e<\/li><li><strong>Secondaire<\/strong> : li\u00e9 \u00e0 une anomalie chromosomique (ex. syndrome de Noonan), une infection ou une malformation lymphatique<\/li><\/ul><\/li><\/ul><p><strong>5.2.2. Signes \u00e9chographiques (2 min)<\/strong><\/p><ul><li><strong>Pr\u00e9sence d\u2019un \u00e9panchement pleural an\u00e9chog\u00e8ne<\/strong><\/li><li><strong>Unilat\u00e9ral (25% des cas) ou bilat\u00e9ral (75%)<\/strong><\/li><li><strong>Compression pulmonaire<\/strong> entra\u00eenant une hypoplasie pulmonaire si s\u00e9v\u00e8re<\/li><li><strong>Possible association avec un hydrops f\u0153tal<\/strong><\/li><\/ul><p><strong>5.2.3. Pronostic et prise en charge (2 min)<\/strong><\/p><ul><li>Surveillance \u00e9chographique de l\u2019\u00e9volution de l\u2019\u00e9panchement<\/li><li><strong>Ponction pleurale f\u0153tale (thoracocent\u00e8se) en cas d\u2019anasarque<\/strong><\/li><li><strong>Shunt pleuro-amniotique en cas de r\u00e9cidive<\/strong><\/li><li>Prise en charge n\u00e9onatale avec ventilation assist\u00e9e si d\u00e9tresse respiratoire<\/li><\/ul><p><strong><em>5.3. Effusions pleurales non chylothoraciques (3 min)<\/em><\/strong><\/p><p><strong>5.3.1. Causes principales (1 min)<\/strong><\/p><ul><li><strong>Hydrops f\u0153tal non immune<\/strong><\/li><li><strong>Infections cong\u00e9nitales (CMV, parvovirus B19)<\/strong><\/li><li><strong>Malformations cardiaques cong\u00e9nitales<\/strong><\/li><li><strong>Tumeurs m\u00e9diastinales<\/strong><\/li><\/ul><p><strong>5.3.2. Signes \u00e9chographiques (1 min)<\/strong><\/p><ul><li><strong>Pr\u00e9sence de liquide pleural isol\u00e9 ou associ\u00e9 \u00e0 un hydramnios<\/strong><\/li><li><strong>Compression pulmonaire variable selon la quantit\u00e9 d\u2019\u00e9panchement<\/strong><\/li><li><strong>\u00c9valuation de l\u2019\u00e9volution et du retentissement sur le c\u0153ur et les poumons<\/strong><\/li><\/ul><p><strong>5.3.3. Prise en charge (1 min)<\/strong><\/p><ul><li>Surveillance pr\u00e9natale par \u00e9chographie r\u00e9guli\u00e8re<\/li><li>Traitement \u00e9tiologique postnatal selon la cause sous-jacente<\/li><li>Possibilit\u00e9 de drainage postnatal en cas d\u2019impact respiratoire<\/li><\/ul><p><strong><em>5.4. Masses m\u00e9diastinales f\u0153tales (5 min)<\/em><\/strong><\/p><p><strong>5.4.1. T\u00e9ratome m\u00e9diastinal (2 min)<\/strong><\/p><ul><li><strong>D\u00e9finition :<\/strong> tumeur b\u00e9nigne contenant des tissus de diff\u00e9rentes origines embryonnaires<\/li><li><strong>Signes \u00e9chographiques :<\/strong><ul><li>Masse <strong>h\u00e9t\u00e9rog\u00e8ne m\u00e9diastinale<\/strong> avec composante kystique et solide<\/li><li>D\u00e9placement du c\u0153ur et compression pulmonaire<\/li><li><strong>Pr\u00e9sence \u00e9ventuelle de calcifications<\/strong><\/li><\/ul><\/li><li><strong>Pronostic et prise en charge :<\/strong><ul><li>Risque de complications cardiovasculaires par compression des gros vaisseaux<\/li><li>Chirurgie postnatale n\u00e9cessaire dans la majorit\u00e9 des cas<\/li><\/ul><\/li><\/ul><p><strong>5.4.2. Kyste bronchog\u00e9nique (1 min)<\/strong><\/p><ul><li><strong>D\u00e9finition :<\/strong> malformation cong\u00e9nitale due \u00e0 une anomalie du d\u00e9veloppement de l\u2019arbre trach\u00e9obronchique<\/li><li><strong>Signes \u00e9chographiques :<\/strong><ul><li>Image <strong>kystique an\u00e9chog\u00e8ne<\/strong> proche de la trach\u00e9e ou des bronches principales<\/li><li>Absence de vascularisation interne<\/li><\/ul><\/li><li><strong>Pronostic et prise en charge :<\/strong><ul><li>Surveillance pr\u00e9natale<\/li><li>Ex\u00e9r\u00e8se chirurgicale postnatale si risque de compression des voies respiratoires<\/li><\/ul><\/li><\/ul><p><strong>5.4.3. S\u00e9questration m\u00e9diastinale (1 min)<\/strong><\/p><ul><li><strong>D\u00e9finition :<\/strong> tissu pulmonaire non fonctionnel situ\u00e9 dans le m\u00e9diastin<\/li><li><strong>Signes \u00e9chographiques :<\/strong><ul><li>Masse <strong>hyper\u00e9chog\u00e8ne<\/strong> m\u00e9diastinale<\/li><li>Mise en \u00e9vidence d\u2019un <strong>vaisseau syst\u00e9mique anormal en Doppler couleur<\/strong><\/li><\/ul><\/li><li><strong>Pronostic et prise en charge :<\/strong><ul><li>Ex\u00e9r\u00e8se chirurgicale postnatale si complications<\/li><\/ul><\/li><\/ul><p><strong><em>5.5. Pathologies du diaphragme (3 min)<\/em><\/strong><\/p><p><strong>5.5.1. Ag\u00e9n\u00e9sie diaphragmatique (1 min)<\/strong><\/p><ul><li><strong>Absence totale du diaphragme<\/strong> entra\u00eenant une ascension massive des organes abdominaux<\/li><li>Signes \u00e9chographiques :<ul><li><strong>Non-visualisation du diaphragme<\/strong><\/li><li>D\u00e9placement important du c\u0153ur et des poumons<\/li><\/ul><\/li><li><strong>Pronostic tr\u00e8s sombre<\/strong> avec d\u00e9c\u00e8s n\u00e9onatal fr\u00e9quent<\/li><\/ul><p><strong>5.5.2. Paralysie diaphragmatique (1 min)<\/strong><\/p><ul><li><strong>Origine :<\/strong> atteinte du nerf phr\u00e9nique<\/li><li><strong>Signes \u00e9chographiques :<\/strong><ul><li><strong>Mouvement paradoxal du diaphragme en mode M<\/strong><\/li><li>Position anormalement haute du diaphragme<\/li><\/ul><\/li><li><strong>Prise en charge :<\/strong><ul><li>Surveillance pr\u00e9natale<\/li><li>Assistance respiratoire n\u00e9onatale si d\u00e9tresse respiratoire<\/li><\/ul><\/li><\/ul><p><strong>5.5.3. Hernie de Morgagni (1 min)<\/strong><\/p><ul><li><strong>D\u00e9finition :<\/strong> d\u00e9faut ant\u00e9rieur du diaphragme avec passage d\u2019organes abdominaux dans le thorax<\/li><li><strong>Signes \u00e9chographiques :<\/strong><ul><li>Image an\u00e9chog\u00e8ne ant\u00e9rieure avec contenu digestif<\/li><li>Absence de d\u00e9placement m\u00e9diastinal important<\/li><\/ul><\/li><li><strong>Pronostic et prise en charge :<\/strong><ul><li>Correction chirurgicale postnatale dans les premiers mois de vie<\/li><\/ul><\/li><\/ul><p><strong><em>5.6. Conclusion et transition vers le chapitre suivant (2 min)<\/em><\/strong><\/p><ul><li>R\u00e9capitulation des pathologies thoraciques rares<\/li><li>Importance du <strong>diagnostic diff\u00e9rentiel et du suivi pr\u00e9natal adapt\u00e9<\/strong><\/li><li>Transition vers <strong>le chapitre 6 sur les implications cliniques et la prise en charge<\/strong><\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1173\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-1173\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Chapitre 6 : Implications cliniques et prise en charge des pathologies thoraciques f\u0153tales <\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1173\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-1173\"><p><strong><em>6.1. Introduction et objectifs du chapitre (2 min)<\/em><\/strong><\/p><ul><li>Comprendre l\u2019impact des anomalies thoraciques f\u0153tales sur la gestion de la grossesse et de l\u2019accouchement<\/li><li>Identifier les strat\u00e9gies de surveillance pr\u00e9natale et les options th\u00e9rapeutiques disponibles<\/li><li>Expliquer l\u2019organisation de la prise en charge postnatale et les perspectives \u00e0 long terme<\/li><\/ul><p><strong><em>6.2. Importance du diagnostic pr\u00e9natal et du suivi \u00e9chographique (4 min)<\/em><\/strong><\/p><p><strong>6.2.1. D\u00e9tection pr\u00e9coce et classification des anomalies (2 min)<\/strong><\/p><ul><li><strong>Identification des anomalies d\u00e8s la 2\u1d49 \u00e9chographie morphologique<\/strong> (22 SA)<\/li><li><strong>Classification des anomalies thoraciques<\/strong> en fonction de :<ul><li>Leur impact sur le <strong>d\u00e9veloppement pulmonaire<\/strong><\/li><li>Leur association \u00e0 d\u2019autres <strong>malformations cong\u00e9nitales<\/strong><\/li><li>Leur \u00e9volution potentielle pendant la grossesse<\/li><\/ul><\/li><\/ul><p><strong>6.2.2. Surveillance \u00e9chographique des cas \u00e0 risque (2 min)<\/strong><\/p><ul><li><strong>Crit\u00e8res de suivi rapproch\u00e9<\/strong> :<ul><li>Volume pulmonaire r\u00e9duit<\/li><li>Signes d\u2019hydrops f\u0153tal<\/li><li>D\u00e9placement m\u00e9diastinal s\u00e9v\u00e8re<\/li><\/ul><\/li><li><strong>Fr\u00e9quence des contr\u00f4les \u00e9chographiques<\/strong> :<ul><li>Tous les <strong>15 jours en cas d\u2019aggravation possible<\/strong><\/li><li>Mensuel en <strong>absence de complications<\/strong><\/li><\/ul><\/li><\/ul><p><strong><em>6.3. Approche multidisciplinaire pour l\u2019orientation de la prise en charge (4 min)<\/em><\/strong><\/p><p><strong>6.3.1. Coordination des sp\u00e9cialistes impliqu\u00e9s (2 min)<\/strong><\/p><ul><li><strong>Obst\u00e9triciens sp\u00e9cialis\u00e9s en m\u00e9decine f\u0153tale<\/strong><\/li><li><strong>Radiologues et \u00e9chographistes sp\u00e9cialis\u00e9s<\/strong><\/li><li><strong>Chirurgiens p\u00e9diatriques<\/strong> pour la planification postnatale<\/li><li><strong>P\u00e9diatres en soins intensifs n\u00e9onatals<\/strong><\/li><\/ul><p><strong>6.3.2. Centres de r\u00e9f\u00e9rence pour les malformations cong\u00e9nitales (2 min)<\/strong><\/p><ul><li><strong>Crit\u00e8res d\u2019orientation vers un centre sp\u00e9cialis\u00e9<\/strong> :<ul><li>Malformations s\u00e9v\u00e8res n\u00e9cessitant une <strong>intervention n\u00e9onatale imm\u00e9diate<\/strong><\/li><li>Pr\u00e9sence d\u2019<strong>hydrops f\u0153tal ou d\u00e9tresse respiratoire anticip\u00e9e<\/strong><\/li><li>Besoin d\u2019<strong>une chirurgie dans les premiers jours de vie<\/strong><\/li><\/ul><\/li><\/ul><p><strong><em>6.4. Options th\u00e9rapeutiques pr\u00e9natales et leur indication (6 min)<\/em><\/strong><\/p><p><strong>6.4.1. Th\u00e9rapies in utero pour les pathologies s\u00e9v\u00e8res (3 min)<\/strong><\/p><ol><li><strong> Thoracocent\u00e8se et shunt pleuro-amniotique<\/strong><\/li><\/ol><ul><li>Indiqu\u00e9 en cas de <strong>chylothorax s\u00e9v\u00e8re avec compression pulmonaire<\/strong><\/li><li><strong>Objectif<\/strong> : \u00e9vacuer l\u2019\u00e9panchement pleural et permettre l\u2019expansion pulmonaire<\/li><li><strong>Proc\u00e9dure<\/strong> :<ul><li>Ponction \u00e9choguid\u00e9e du liquide pleural<\/li><li>Mise en place d\u2019un shunt pleuro-amniotique si r\u00e9cidive<\/li><\/ul><\/li><\/ul><ol start=\"2\"><li><strong> Occlusion trach\u00e9ale f\u0153toscopique (FETO) pour HDC s\u00e9v\u00e8re<\/strong><\/li><\/ol><ul><li>R\u00e9serv\u00e9 aux <strong>cas de hernie diaphragmatique avec LHR &lt; 25%<\/strong><\/li><li><strong>Objectif<\/strong> : favoriser la croissance pulmonaire en bloquant l\u2019\u00e9vacuation du liquide pulmonaire<\/li><li><strong>Proc\u00e9dure<\/strong> : insertion d\u2019un ballon dans la trach\u00e9e f\u0153tale \u00e0 26-30 SA, retir\u00e9 avant la naissance<\/li><\/ul><p><strong>6.4.2. Indications d\u2019une extraction n\u00e9onatale anticip\u00e9e (3 min)<\/strong><\/p><ul><li><strong>Crit\u00e8res d\u2019accouchement pr\u00e9matur\u00e9 planifi\u00e9<\/strong> :<ul><li>Hydrops f\u0153tal \u00e9volutif<\/li><li>Insuffisance cardiaque f\u0153tale<\/li><\/ul><\/li><li><strong>Voie d\u2019accouchement privil\u00e9gi\u00e9e<\/strong> :<ul><li><strong>C\u00e9sarienne programm\u00e9e<\/strong> en cas de masse m\u00e9diastinale compressive<\/li><li><strong>Accouchement par voie basse possible<\/strong> si absence de d\u00e9tresse f\u0153tale<\/li><\/ul><\/li><\/ul><p><strong><em>6.5. Prise en charge n\u00e9onatale et suivi \u00e0 long terme (4 min)<\/em><\/strong><\/p><p><strong>6.5.1. R\u00e9animation et soins intensifs apr\u00e8s la naissance (2 min)<\/strong><\/p><ul><li><strong>Prise en charge imm\u00e9diate en salle d\u2019accouchement<\/strong> :<ul><li>Intubation rapide en cas de d\u00e9tresse respiratoire<\/li><li>Ventilation non invasive ou oxyg\u00e9noth\u00e9rapie selon le degr\u00e9 d\u2019hypoplasie pulmonaire<\/li><\/ul><\/li><li><strong>Transfert en unit\u00e9 de soins intensifs n\u00e9onatals (USIN)<\/strong><ul><li>Monitoring des fonctions respiratoires et h\u00e9modynamiques<\/li><li>Pr\u00e9paration \u00e0 la chirurgie n\u00e9onatale si n\u00e9cessaire<\/li><\/ul><\/li><\/ul><p><strong>6.5.2. Strat\u00e9gies chirurgicales et post-op\u00e9ratoires (1 min)<\/strong><\/p><ul><li><strong>Correction chirurgicale de la hernie diaphragmatique<\/strong> dans les <strong>premiers jours de vie<\/strong><\/li><li><strong>R\u00e9section des masses pulmonaires<\/strong> (MAKP, s\u00e9questration) en fonction de leur \u00e9volution<\/li><li><strong>Prise en charge des complications post-op\u00e9ratoires<\/strong> (infection, d\u00e9tresse respiratoire prolong\u00e9e)<\/li><\/ul><p><strong>6.5.3. Suivi \u00e0 long terme et \u00e9valuation du d\u00e9veloppement pulmonaire (1 min)<\/strong><\/p><ul><li><strong>Consultations de suivi en pneumologie p\u00e9diatrique<\/strong><ul><li>Surveillance de la <strong>fonction pulmonaire<\/strong> et de la croissance<\/li><li>\u00c9valuation des troubles de l\u2019alimentation et du reflux gastro-\u0153sophagien<\/li><\/ul><\/li><li><strong>Kin\u00e9sith\u00e9rapie respiratoire en cas de s\u00e9quelles pulmonaires<\/strong><\/li><\/ul><p><strong><em>6.6. Conclusion et transition vers le chapitre final (2 min)<\/em><\/strong><\/p><ul><li>Importance d\u2019une <strong>prise en charge personnalis\u00e9e<\/strong> en fonction de la s\u00e9v\u00e9rit\u00e9 des anomalies<\/li><li>Coordination entre <strong>diagnostic pr\u00e9natal, interventions f\u0153tales et soins n\u00e9onatals<\/strong><\/li><li>Transition vers <strong>le chapitre 7 : Conclusion g\u00e9n\u00e9rale et discussion<\/strong><\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-869f46e elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"869f46e\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-dbbe598\" data-id=\"dbbe598\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f9d8374 elementor-widget elementor-widget-text-editor\" data-id=\"f9d8374\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: justify;\">FAQ<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c98ce1d elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"c98ce1d\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-b5dbb7d elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"b5dbb7d\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-28c68ae\" data-id=\"28c68ae\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-da58028 elementor-widget elementor-widget-toggle\" data-id=\"da58028\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2281\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-2281\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">\u2753 Q1 : \u00c0 quel moment de la grossesse l\u2019\u00e9chographie du thorax f\u0153tal est-elle r\u00e9alis\u00e9e ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2281\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-2281\"><p>\u2705 L\u2019\u00e9valuation thoracique f\u0153tale peut \u00eatre faite d\u00e8s la <strong>2\u1d49 \u00e9chographie morphologique (22 SA)<\/strong> et \u00eatre approfondie en cas d\u2019anomalie d\u00e9tect\u00e9e.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2282\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-2282\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">\u2753 Q2 : Quelle est l\u2019utilit\u00e9 du Doppler couleur dans l\u2019\u00e9tude du thorax f\u0153tal ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2282\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-2282\"><p>\u2705 Il permet de visualiser la <strong>vascularisation pulmonaire<\/strong>, d\u2019identifier des anomalies comme une <strong>s\u00e9questration pulmonaire<\/strong> et d\u2019\u00e9valuer les flux sanguins cardiaques.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2283\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-2283\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">\u2753 Q3 : Pourquoi utilise-t-on le mode M en \u00e9chographie thoracique f\u0153tale ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2283\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-2283\"><p>\u2705 Il permet d\u2019\u00e9tudier le <strong>mouvement diaphragmatique<\/strong>, notamment en cas de suspicion de <strong>paralysie diaphragmatique<\/strong>.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2284\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-2284\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">\u2753 Q4 : Quelles sont les trois principales coupes \u00e9chographiques utilis\u00e9es pour analyser le thorax f\u0153tal ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2284\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-2284\"><p>\u2705<\/p><ul><li><strong>Coupe axiale<\/strong> : permet d\u2019\u00e9valuer les poumons, le diaphragme et la position du c\u0153ur.<\/li><li><strong>Coupe longitudinale parasagittale<\/strong> : utile pour analyser la continuit\u00e9 du diaphragme.<\/li><li><strong>Coupe coronale<\/strong> : donne une vue d\u2019ensemble du thorax et des poumons.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2285\" class=\"elementor-tab-title\" data-tab=\"5\" role=\"button\" aria-controls=\"elementor-tab-content-2285\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">\u2753 Q5 : Pourquoi la coupe axiale est-elle essentielle dans l\u2019\u00e9tude du thorax f\u0153tal ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2285\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"5\" role=\"region\" aria-labelledby=\"elementor-tab-title-2285\"><p>\u2705 Elle permet une <strong>analyse globale du volume pulmonaire<\/strong>, la d\u00e9tection d\u2019un <strong>d\u00e9placement m\u00e9diastinal<\/strong> et l\u2019identification des <strong>hernies diaphragmatiques cong\u00e9nitales (HDC)<\/strong>.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2286\" class=\"elementor-tab-title\" data-tab=\"6\" role=\"button\" aria-controls=\"elementor-tab-content-2286\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">\u2753 Q6 : Comment \u00e9volue l\u2019\u00e9chog\u00e9nicit\u00e9 pulmonaire au cours de la grossesse ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2286\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"6\" role=\"region\" aria-labelledby=\"elementor-tab-title-2286\"><p>\u2705 Les poumons sont initialement <strong>hypo\u00e9chog\u00e8nes<\/strong> et deviennent progressivement <strong>hyper\u00e9chog\u00e8nes<\/strong> en raison du d\u00e9veloppement des structures alv\u00e9olaires.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2287\" class=\"elementor-tab-title\" data-tab=\"7\" role=\"button\" aria-controls=\"elementor-tab-content-2287\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">\u2753 Q7 : Quels param\u00e8tres \u00e9chographiques permettent d\u2019\u00e9valuer la croissance pulmonaire ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2287\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"7\" role=\"region\" aria-labelledby=\"elementor-tab-title-2287\"><p>\u2705 Le <strong>Lung-to-Head Ratio (LHR)<\/strong> et le <strong>volume pulmonaire en IRM (O\/E-TFLV)<\/strong> sont les principaux outils pronostiques pour l\u2019\u00e9valuation de l\u2019hypoplasie pulmonaire.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2288\" class=\"elementor-tab-title\" data-tab=\"8\" role=\"button\" aria-controls=\"elementor-tab-content-2288\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">\u2753 Q8 : Quelles anomalies \u00e9chographiques sugg\u00e8rent une hypoplasie pulmonaire ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2288\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"8\" role=\"region\" aria-labelledby=\"elementor-tab-title-2288\"><p>\u2705 Une <strong>r\u00e9duction du volume pulmonaire<\/strong>, un <strong>d\u00e9placement m\u00e9diastinal<\/strong> et un <strong>LHR inf\u00e9rieur \u00e0 1<\/strong> sont des signes \u00e9vocateurs.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2289\" class=\"elementor-tab-title\" data-tab=\"9\" role=\"button\" aria-controls=\"elementor-tab-content-2289\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">\u2753 Q9 : Quels sont les signes \u00e9chographiques typiques d\u2019une hernie diaphragmatique cong\u00e9nitale (HDC) ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2289\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"9\" role=\"region\" aria-labelledby=\"elementor-tab-title-2289\"><p>\u2705 D\u00e9placement du <strong>c\u0153ur vers le c\u00f4t\u00e9 oppos\u00e9<\/strong>, <strong>pr\u00e9sence d\u2019organes abdominaux (estomac, foie) dans le thorax<\/strong> et absence de continuit\u00e9 du <strong>diaphragme<\/strong>.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-dd31a45\" data-id=\"dd31a45\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f90cbf7 elementor-widget elementor-widget-toggle\" data-id=\"f90cbf7\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2611\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-2611\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">\u2753 Q10 : Comment diff\u00e9rencier une s\u00e9questration pulmonaire d\u2019une maladie ad\u00e9nomato\u00efde kystique pulmonaire (MAKP) ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2611\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-2611\"><p>\u2705 La <strong>s\u00e9questration pulmonaire<\/strong> pr\u00e9sente une <strong>vascularisation syst\u00e9mique anormale<\/strong> visible en Doppler, tandis que la <strong>MAKP<\/strong> est caract\u00e9ris\u00e9e par une <strong>masse kystique sans vascularisation syst\u00e9mique propre<\/strong>.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2612\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-2612\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">\u2753 Q11 : Quels sont les signes \u00e9chographiques d\u2019un chylothorax cong\u00e9nital ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2612\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-2612\"><p>\u2705 <strong>Pr\u00e9sence d\u2019un \u00e9panchement pleural an\u00e9chog\u00e8ne<\/strong>, souvent bilat\u00e9ral, pouvant provoquer une <strong>compression pulmonaire<\/strong> et \u00eatre associ\u00e9 \u00e0 un <strong>hydrops f\u0153tal<\/strong>.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2613\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-2613\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">\u2753 Q12 : Comment identifier un t\u00e9ratome m\u00e9diastinal en \u00e9chographie ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2613\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-2613\"><p>\u2705 Il appara\u00eet comme une <strong>masse h\u00e9t\u00e9rog\u00e8ne<\/strong> contenant des \u00e9l\u00e9ments solides et kystiques, parfois avec des <strong>calcifications<\/strong> visibles.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2614\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-2614\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">\u2753 Q13 : Quels sont les crit\u00e8res \u00e9chographiques n\u00e9cessitant une surveillance rapproch\u00e9e ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2614\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-2614\"><p>\u2705 La <strong>pr\u00e9sence d\u2019hydrops f\u0153tal<\/strong>, une <strong>croissance excessive d\u2019une masse thoracique<\/strong>, un <strong>d\u00e9placement important du m\u00e9diastin<\/strong> et une <strong>baisse du LHR<\/strong>.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2615\" class=\"elementor-tab-title\" data-tab=\"5\" role=\"button\" aria-controls=\"elementor-tab-content-2615\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">\u2753 Q14 : \u00c0 quelle fr\u00e9quence faut-il r\u00e9aliser des \u00e9chographies de suivi pour une malformation thoracique ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2615\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"5\" role=\"region\" aria-labelledby=\"elementor-tab-title-2615\"><p>\u2705 Tous les <strong>15 jours en cas de malformation s\u00e9v\u00e8re<\/strong>, mensuellement si <strong>absence de complications \u00e9volutives<\/strong>.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2616\" class=\"elementor-tab-title\" data-tab=\"6\" role=\"button\" aria-controls=\"elementor-tab-content-2616\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">\u2753 Q15 : Pourquoi l\u2019\u00e9valuation \u00e9chographique influence-t-elle la d\u00e9cision du mode d\u2019accouchement ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2616\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"6\" role=\"region\" aria-labelledby=\"elementor-tab-title-2616\"><p>\u2705 Une <strong>masse volumineuse compressive<\/strong>, un <strong>hydrops f\u0153tal s\u00e9v\u00e8re<\/strong> ou une <strong>HDC majeure<\/strong> peuvent justifier une <strong>c\u00e9sarienne programm\u00e9e<\/strong> pour optimiser la prise en charge n\u00e9onatale.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2617\" class=\"elementor-tab-title\" data-tab=\"7\" role=\"button\" aria-controls=\"elementor-tab-content-2617\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">\u2753 Q16 : Quel est le r\u00f4le de l\u2019\u00e9chographie dans la planification des interventions postnatales ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2617\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"7\" role=\"region\" aria-labelledby=\"elementor-tab-title-2617\"><p>\u2705 Elle permet d\u2019anticiper le <strong>niveau de soins n\u00e9onatals n\u00e9cessaires<\/strong>, d\u2019organiser <strong>une prise en charge chirurgicale pr\u00e9coce<\/strong> et de choisir le centre de naissance adapt\u00e9.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2618\" class=\"elementor-tab-title\" data-tab=\"8\" role=\"button\" aria-controls=\"elementor-tab-content-2618\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">\u2753 Q17 : Comment l\u2019\u00e9chographie 3D\/4D am\u00e9liore-t-elle l\u2019\u00e9valuation du thorax f\u0153tal ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2618\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"8\" role=\"region\" aria-labelledby=\"elementor-tab-title-2618\"><p>\u2705 Elle permet une <strong>visualisation plus pr\u00e9cise du volume pulmonaire<\/strong>, une meilleure diff\u00e9renciation des structures m\u00e9diastinales et l\u2019<strong>\u00e9valuation d\u00e9taill\u00e9e des anomalies diaphragmatiques<\/strong>.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2619\" class=\"elementor-tab-title\" data-tab=\"9\" role=\"button\" aria-controls=\"elementor-tab-content-2619\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">\u2753 Q18 : Quels sont les avantages de l\u2019IRM par rapport \u00e0 l\u2019\u00e9chographie pour l\u2019\u00e9valuation thoracique f\u0153tale ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2619\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"9\" role=\"region\" aria-labelledby=\"elementor-tab-title-2619\"><p>\u2705 L\u2019IRM est plus performante pour <strong>quantifier le volume pulmonaire (O\/E-TFLV)<\/strong>, mieux visualiser les <strong>structures m\u00e9diastinales<\/strong> et d\u00e9tecter certains d\u00e9tails invisibles en \u00e9chographie.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-c06ff0a elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"c06ff0a\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-355f3bc\" data-id=\"355f3bc\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a07df8a elementor-widget elementor-widget-text-editor\" data-id=\"a07df8a\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: justify;\">QCM<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-084f553 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"084f553\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-6a95fff elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"6a95fff\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-a97af1a\" data-id=\"a97af1a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-999692b elementor-widget elementor-widget-toggle\" data-id=\"999692b\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1611\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-1611\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">QCM 1-10<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1611\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-1611\"><ol><li><strong> Quels param\u00e8tres \u00e9chographiques permettent d\u2019\u00e9valuer une hypoplasie pulmonaire ?<\/strong><\/li><\/ol><p>\u2705 <strong>R\u00e9ponses correctes :<\/strong> A, B, C<\/p><ol><li>A) Lung-to-Head Ratio (LHR) \u2705<br \/>B) Volume pulmonaire observ\u00e9\/attendu (O\/E-TFLV) \u2705<br \/>C) Position du foie \u2705<br \/>D) Index de r\u00e9sistance des art\u00e8res pulmonaires \u274c<br \/>E) Longueur f\u00e9morale \u274c<\/li><\/ol><p><strong>\u00a0<\/strong><\/p><ol start=\"2\"><li><strong> Quels sont les signes \u00e9chographiques \u00e9vocateurs d\u2019une hernie diaphragmatique cong\u00e9nitale ?<\/strong><\/li><\/ol><p>\u2705 <strong>R\u00e9ponses correctes :<\/strong> A, B, C, D<\/p><ol><li>A) D\u00e9placement du c\u0153ur \u2705<br \/>B) Pr\u00e9sence d\u2019organes abdominaux dans le thorax \u2705<br \/>C) Absence de visualisation du diaphragme \u2705<br \/>D) Hydramnios \u2705<br \/>E) Poumons hyper\u00e9chog\u00e8nes \u274c<\/li><\/ol><p>\u00a0<\/p><ol start=\"3\"><li><strong> Quels \u00e9l\u00e9ments permettent de diff\u00e9rencier une s\u00e9questration pulmonaire d\u2019une maladie ad\u00e9nomato\u00efde kystique pulmonaire (MAKP) ?<\/strong><\/li><\/ol><p>\u2705 <strong>R\u00e9ponses correctes :<\/strong> A, B, D<\/p><ol><li>A) Pr\u00e9sence d\u2019une vascularisation syst\u00e9mique anormale en Doppler \u2705<br \/>B) Absence de connexion avec l\u2019arbre bronchique \u2705<br \/>C) Pr\u00e9sence de multiples kystes de tailles variables \u274c<br \/>D) Masse hyper\u00e9chog\u00e8ne homog\u00e8ne \u2705<br \/>E) Association fr\u00e9quente avec une cardiom\u00e9galie \u274c<\/li><li><strong> Quels sont les signes \u00e9chographiques d\u2019un chylothorax f\u0153tal ?<\/strong><\/li><\/ol><p>\u2705 <strong>R\u00e9ponses correctes :<\/strong> A, B, C, E<\/p><ol><li>A) \u00c9panchement pleural an\u00e9chog\u00e8ne \u2705<br \/>B) Hydrops f\u0153tal \u2705<br \/>C) Compression pulmonaire \u2705<br \/>D) Pr\u00e9sence de kystes pulmonaires \u274c<br \/>E) Possible r\u00e9gression spontan\u00e9e \u2705<\/li><\/ol><p><strong><em>4. Quels sont les r\u00f4les du Doppler couleur en \u00e9chographie thoracique f\u0153tale ?<\/em><\/strong><\/p><p>\u2705 <strong>R\u00e9ponses correctes :<\/strong> A, C, D<\/p><ol><li>A) \u00c9valuation de la vascularisation pulmonaire \u2705<br \/>B) Identification des kystes pulmonaires \u274c<br \/>C) Mise en \u00e9vidence d\u2019une art\u00e8re syst\u00e9mique dans la s\u00e9questration pulmonaire \u2705<br \/>D) \u00c9tude du flux dans l\u2019art\u00e8re pulmonaire \u2705<br \/>E) Mesure de la taille des poumons \u274c<\/li><\/ol><p><strong><em>5. Quels \u00e9l\u00e9ments visibles en \u00e9chographie sugg\u00e8rent une paralysie diaphragmatique ?<\/em><\/strong><\/p><p>\u2705 <strong>R\u00e9ponses correctes :<\/strong> A, C, D<\/p><ol><li>A) Mouvement paradoxal du diaphragme \u2705<br \/>B) Hyper\u00e9chog\u00e9nicit\u00e9 pulmonaire \u274c<br \/>C) Position anormalement haute du diaphragme \u2705<br \/>D) Absence de mouvement diaphragmatique \u2705<br \/>E) Pr\u00e9sence d\u2019un \u00e9panchement pleural bilat\u00e9ral \u274c<\/li><li><strong><em> Quelles anomalies peuvent \u00eatre associ\u00e9es \u00e0 une hernie diaphragmatique cong\u00e9nitale ?<\/em><\/strong><\/li><\/ol><p>\u2705 <strong>R\u00e9ponses correctes :<\/strong> A, B, C, E<\/p><ol><li>A) Malformations cardiaques \u2705<br \/>B) Anomalies chromosomiques \u2705<br \/>C) Hypoplasie pulmonaire \u2705<br \/>D) S\u00e9questration pulmonaire \u274c<br \/>E) Anomalies digestives \u2705<\/li><\/ol><p><strong><em>7. Quels \u00e9l\u00e9ments permettent de suspecter un t\u00e9ratome m\u00e9diastinal en \u00e9chographie ?<\/em><\/strong><\/p><p>\u2705 <strong>R\u00e9ponses correctes :<\/strong> A, B, D<\/p><ol><li>A) Masse m\u00e9diastinale h\u00e9t\u00e9rog\u00e8ne \u2705<br \/>B) Pr\u00e9sence de calcifications \u2705<br \/>C) Absence de d\u00e9placement m\u00e9diastinal \u274c<br \/>D) Compression cardiaque possible \u2705<br \/>E) Visualisation d\u2019un canal art\u00e9riel dilat\u00e9 \u274c<\/li><\/ol><p><strong><em>8. Quelles structures sont visibles en coupe longitudinale parasagittale du thorax f\u0153tal ?<\/em><\/strong><\/p><p>\u2705 <strong>R\u00e9ponses correctes :<\/strong> A, C, D<\/p><ol><li>A) Diaphragme \u2705<br \/>B) Rate \u274c<br \/>C) Foie \u2705<br \/>D) Poumon \u2705<br \/>E) Rein \u274c<\/li><\/ol><p><strong><em>9. Quelles interventions pr\u00e9natales peuvent \u00eatre envisag\u00e9es pour une pathologie thoracique f\u0153tale ?<\/em><\/strong><\/p><p>\u2705 <strong>R\u00e9ponses correctes :<\/strong> A, C, D<\/p><ol><li>A) Thoracocent\u00e8se f\u0153tale \u2705<br \/>B) Intubation pr\u00e9natale \u274c<br \/>C) Mise en place d\u2019un shunt pleuro-amniotique \u2705<br \/>D) Occlusion trach\u00e9ale f\u0153toscopique (FETO) \u2705<br \/>E) Transfusion intra-ut\u00e9rine \u274c<\/li><\/ol><p><strong><em>10. Quelles conditions peuvent \u00eatre associ\u00e9es \u00e0 un hydramnios en cas de pathologie thoracique f\u0153tale ?<\/em><\/strong><\/p><p>\u2705 <strong>R\u00e9ponses correctes :<\/strong> A, B, D<\/p><ol><li>A) Compression de l\u2019\u0153sophage \u2705<br \/>B) Hernie diaphragmatique \u2705<br \/>C) S\u00e9questration pulmonaire isol\u00e9e \u274c<br \/>D) Malformation m\u00e9diastinale volumineuse \u2705<br \/>E) Insuffisance r\u00e9nale f\u0153tale \u274c<\/li><\/ol><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1612\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-1612\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">QCM 11-20<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1612\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-1612\"><p><strong><em>11. Quelles sont les principales causes d\u2019effusion pleurale f\u0153tale visibles en \u00e9chographie ?<\/em><\/strong><\/p><p>\u2705 <strong>R\u00e9ponses correctes :<\/strong> A, B, C, D<\/p><ol><li><p>A) Chylothorax cong\u00e9nital \u2705<\/p><p>B) Hydrops f\u0153tal \u2705<\/p><p>C) Malformation cardiaque \u2705<\/p><p>D) Infection cong\u00e9nitale (CMV, parvovirus B19) \u2705<\/p><p>E) Atr\u00e9sie de l\u2019\u0153sophage \u274c<\/p><\/li><\/ol><p><strong><em>12. Quels sont les r\u00f4les de l\u2019\u00e9chographie dans la planification de l\u2019accouchement en cas de pathologie thoracique f\u0153tale ?<\/em><\/strong><\/p><p>\u2705 <strong>R\u00e9ponses correctes :<\/strong> A, B, C, E<\/p><ol><li><p>A) \u00c9valuation de la s\u00e9v\u00e9rit\u00e9 de l\u2019hypoplasie pulmonaire \u2705<\/p><p>B) D\u00e9termination du mode d\u2019accouchement (voie basse vs c\u00e9sarienne) \u2705<\/p><p>C) D\u00e9cision d\u2019un transfert vers un centre de niveau III \u2705<\/p><p>D) D\u00e9tection des anomalies chromosomiques \u274c<\/p><p>E) Anticipation d\u2019une ventilation n\u00e9onatale imm\u00e9diate \u2705<\/p><\/li><\/ol><p><strong><em>13. Quels \u00e9l\u00e9ments doivent \u00eatre analys\u00e9s en cas de suspicion de pathologie diaphragmatique en \u00e9chographie ?<\/em><\/strong><\/p><p>\u2705 <strong>R\u00e9ponses correctes :<\/strong> A, B, C, D<\/p><ol><li><p>A) Position et continuit\u00e9 du diaphragme \u2705<\/p><p>B) Pr\u00e9sence d\u2019organes abdominaux dans le thorax \u2705<\/p><p>C) D\u00e9viation du c\u0153ur \u2705<\/p><p>D) \u00c9valuation du mouvement diaphragmatique en mode M \u2705<\/p><p>E) Longueur du f\u00e9mur \u274c<\/p><\/li><\/ol><p><strong><em>14. Quels param\u00e8tres \u00e9chographiques sont essentiels pour \u00e9valuer le pronostic d\u2019une malformation pulmonaire cong\u00e9nitale ?<\/em><\/strong><\/p><p>\u2705 <strong>R\u00e9ponses correctes :<\/strong> A, B, C, D<\/p><ol><li><p>A) Lung-to-Head Ratio (LHR) \u2705<\/p><p>B) Volume pulmonaire observ\u00e9\/attendu (O\/E-TFLV) \u2705<\/p><p>C) Pr\u00e9sence ou absence d\u2019hydrops f\u0153tal \u2705<\/p><p>D) D\u00e9placement m\u00e9diastinal \u2705<\/p><p>E) \u00c9paisseur du placenta \u274c<\/p><\/li><\/ol><p><strong>\u00a0<\/strong><\/p><p><strong><em>15 : Quel est le diagnostic le plus probable sur cette image \u00e9chographique ?<\/em><\/strong><\/p><p><a href=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/FIGURE-1-Prise-en-charge-prEnatale-des-chylothorax-.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-5096 aligncenter\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/FIGURE-1-Prise-en-charge-prEnatale-des-chylothorax--300x226.jpg\" alt=\"\" width=\"300\" height=\"226\" srcset=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/FIGURE-1-Prise-en-charge-prEnatale-des-chylothorax--300x226.jpg 300w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/FIGURE-1-Prise-en-charge-prEnatale-des-chylothorax-.jpg 700w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><\/p><p>A) Hernie diaphragmatique cong\u00e9nitale<\/p><p>B) Chylothorax f\u0153tal<\/p><p>C) Atr\u00e9sie de l\u2019\u0153sophage<\/p><p>D) S\u00e9questration pulmonaire<\/p><p>E) Tumeur m\u00e9diastinale<\/p><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><p><strong>B) Chylothorax f\u0153tal<\/strong><\/p><\/li><\/ul><p>Explication : L\u2019image montre une coupe transverse du thorax f\u0153tal avec un \u00e9panchement pleural bilat\u00e9ral important, typique d\u2019un <strong>chylothorax cong\u00e9nital<\/strong>.<\/p><p>\u00a0<\/p><p><strong><em>16 : Quels sont les signes \u00e9chographiques associ\u00e9s au chylothorax f\u0153tal ?<\/em><\/strong><\/p><ol><li><p>A) Pr\u00e9sence de liquide an\u00e9chog\u00e8ne autour des poumons<\/p><p>B) D\u00e9placement m\u00e9diastinal<\/p><p>C) Ascite f\u0153tale associ\u00e9e<\/p><p>D) Hypoplasie pulmonaire<\/p><p>E) Calcifications thoraciques<\/p><\/li><\/ol><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><p><strong>A) Pr\u00e9sence de liquide an\u00e9chog\u00e8ne autour des poumons<\/strong><\/p><\/li><li><p><strong>B) D\u00e9placement m\u00e9diastinal<\/strong><\/p><\/li><li><p><strong>C) Ascite f\u0153tale associ\u00e9e<\/strong><\/p><\/li><li><p><strong>D) Hypoplasie pulmonaire<\/strong><\/p><\/li><\/ul><p>Explication : Le chylothorax se manifeste par un <strong>\u00e9panchement pleural an\u00e9chog\u00e8ne<\/strong>, pouvant entra\u00eener un <strong>d\u00e9placement du m\u00e9diastin<\/strong>, une <strong>ascite<\/strong> (si hydrops f\u0153tal) et une <strong>hypoplasie pulmonaire<\/strong> en cas de compression prolong\u00e9e.<\/p><p><strong><em>17 : Quelle est la prise en charge pr\u00e9natale d\u2019un chylothorax volumineux ?<\/em><\/strong><\/p><ol><li><p>A) Surveillance \u00e9chographique rapproch\u00e9e<\/p><p>B) Ponction pleurale in utero<\/p><p>C) Pose d\u2019un shunt pleuro-amniotique<\/p><p>D) Administration de cortico\u00efdes pour la maturation pulmonaire<\/p><p>E) Transfusion intra-ut\u00e9rine syst\u00e9matique<\/p><\/li><\/ol><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><p><strong>A) Surveillance \u00e9chographique rapproch\u00e9e<\/strong><\/p><\/li><li><p><strong>B) Ponction pleurale in utero<\/strong><\/p><\/li><li><p><strong>C) Pose d\u2019un shunt pleuro-amniotique<\/strong><\/p><\/li><li><p><strong>D) Administration de cortico\u00efdes pour la maturation pulmonaire<\/strong><\/p><\/li><\/ul><p>Explication : La prise en charge inclut une <strong>surveillance \u00e9chographique<\/strong>, une <strong>ponction pleurale en cas de compression s\u00e9v\u00e8re<\/strong>, et parfois la mise en place d\u2019un <strong>shunt pleuro-amniotique<\/strong> si r\u00e9cidive. Les <strong>cortico\u00efdes<\/strong> sont indiqu\u00e9s pour favoriser la maturation pulmonaire.<\/p><p><strong><em>18 : Quels sont les facteurs de mauvais pronostic en cas de chylothorax cong\u00e9nital ?<\/em><\/strong><\/p><ol><li><p>A) Pr\u00e9sence d\u2019un hydrops f\u0153tal<\/p><p>B) \u00c9panchement pleural unilat\u00e9ral mod\u00e9r\u00e9<\/p><p>C) Hypoplasie pulmonaire s\u00e9v\u00e8re<\/p><p>D) Association \u00e0 une anomalie chromosomique<\/p><p>E) Am\u00e9lioration spontan\u00e9e du chylothorax en cours de grossesse<\/p><\/li><\/ol><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><p><strong>A) Pr\u00e9sence d\u2019un hydrops f\u0153tal<\/strong><\/p><\/li><li><p><strong>C) Hypoplasie pulmonaire s\u00e9v\u00e8re<\/strong><\/p><\/li><li><p><strong>D) Association \u00e0 une anomalie chromosomique<\/strong><\/p><\/li><\/ul><p>Explication : Un <strong>hydrops f\u0153tal<\/strong>, une <strong>hypoplasie pulmonaire<\/strong> importante et une <strong>\u00e9tiologie syndromique<\/strong> sont des facteurs de <strong>mauvais pronostic<\/strong>. Un \u00e9panchement <strong>mod\u00e9r\u00e9 unilat\u00e9ral<\/strong> ou une <strong>r\u00e9solution spontan\u00e9e<\/strong> sont des signes plut\u00f4t favorables.<\/p><p>\u00a0<\/p><p><strong><em>19 : Quel est le diagnostic le plus probable sur cette image \u00e9chographique ?<\/em><\/strong><\/p><p><a href=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-1-article-Prenatal-diagnosis-imaging-and-prognosis-in-Congenital-Diaphragmatic-Hernia.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-5097 aligncenter\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-1-article-Prenatal-diagnosis-imaging-and-prognosis-in-Congenital-Diaphragmatic-Hernia-300x280.jpg\" alt=\"\" width=\"300\" height=\"280\" srcset=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-1-article-Prenatal-diagnosis-imaging-and-prognosis-in-Congenital-Diaphragmatic-Hernia-300x280.jpg 300w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-1-article-Prenatal-diagnosis-imaging-and-prognosis-in-Congenital-Diaphragmatic-Hernia.jpg 700w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><\/p><ol><li><p>A) Hernie diaphragmatique cong\u00e9nitale (HDC)<\/p><p>B) Chylothorax f\u0153tal<\/p><p>C) Atr\u00e9sie de l\u2019\u0153sophage<\/p><p>D) S\u00e9questration pulmonaire<\/p><p>E) Malformation ad\u00e9nomato\u00efde kystique du poumon (CCAM)<\/p><\/li><\/ol><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><p><strong>A) Hernie diaphragmatique cong\u00e9nitale (HDC)<\/strong><\/p><\/li><\/ul><p><strong>Explication<\/strong> : L\u2019image montre une <strong>coupe axiale thoracique f\u0153tale<\/strong> avec un <strong>estomac intra-thoracique<\/strong>, une <strong>d\u00e9viation m\u00e9diastinale<\/strong> et une <strong>anomalie du positionnement des organes abdominaux<\/strong>, \u00e9vocateurs d\u2019une <strong>HDC<\/strong>.<\/p><p>\u00a0<\/p><p><strong><em>20 : Quels sont les signes \u00e9chographiques typiques d\u2019une hernie diaphragmatique cong\u00e9nitale ?<\/em><\/strong><\/p><ol><li><p>A) D\u00e9placement du m\u00e9diastin vers le c\u00f4t\u00e9 oppos\u00e9<\/p><p>B) Estomac et\/ou anses intestinales en position thoracique<\/p><p>C) Hypoplasie pulmonaire du c\u00f4t\u00e9 atteint<\/p><p>D) Visualisation du foie intra-thoracique dans certains cas<\/p><p>E) Pr\u00e9sence d\u2019une ascite isol\u00e9e<\/p><\/li><\/ol><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><p><strong>A) D\u00e9placement du m\u00e9diastin vers le c\u00f4t\u00e9 oppos\u00e9<\/strong><\/p><\/li><li><p><strong>B) Estomac et\/ou anses intestinales en position thoracique<\/strong><\/p><\/li><li><p><strong>C) Hypoplasie pulmonaire du c\u00f4t\u00e9 atteint<\/strong><\/p><\/li><li><p><strong>D) Visualisation du foie intra-thoracique dans certains cas<\/strong><\/p><\/li><\/ul><p><strong>Explication<\/strong> : L\u2019HDC est caract\u00e9ris\u00e9e par un <strong>d\u00e9placement du m\u00e9diastin<\/strong> et une <strong>mont\u00e9e des structures digestives dans le thorax<\/strong>. Elle peut \u00eatre <strong>gauche (plus fr\u00e9quente) ou droite<\/strong>, avec parfois une <strong>herniation du foie<\/strong>. Une ascite isol\u00e9e <strong>n\u2019est pas un signe sp\u00e9cifique<\/strong>.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1613\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-1613\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">QCM 21-30<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1613\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-1613\"><p><strong><em>21 : Quelle est la m\u00e9thode \u00e9chographique permettant d\u2019\u00e9valuer la s\u00e9v\u00e9rit\u00e9 d\u2019une hernie diaphragmatique cong\u00e9nitale ?<\/em><\/strong><\/p><ol><li><p>A) Mesure du rapport t\u00eate\/circonf\u00e9rence abdominale (HC\/AC)<\/p><p>B) Calcul du Lung-to-Head Ratio (LHR)<\/p><p>C) Doppler de l\u2019art\u00e8re pulmonaire<\/p><p>D) IRM f\u0153tale pour \u00e9valuer le volume pulmonaire<\/p><p>E) Mesure de la longueur du diaphragme<\/p><\/li><\/ol><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><p><strong>B) Calcul du Lung-to-Head Ratio (LHR)<\/strong><\/p><\/li><li><p><strong>D) IRM f\u0153tale pour \u00e9valuer le volume pulmonaire<\/strong><\/p><\/li><\/ul><p><strong>Explication<\/strong> : Le <strong>LHR<\/strong> est un param\u00e8tre cl\u00e9 en \u00e9chographie pour \u00e9valuer la s\u00e9v\u00e9rit\u00e9 de l\u2019HDC. L\u2019<strong>IRM f\u0153tale<\/strong> permet une estimation plus pr\u00e9cise du <strong>volume pulmonaire r\u00e9siduel<\/strong>.<\/p><p><strong><em>22 : Quels sont les facteurs \u00e9chographiques associ\u00e9s \u00e0 un mauvais pronostic dans l\u2019HDC ?<\/em><\/strong><\/p><ol><li><p>A) LHR &lt; 1.0<\/p><p>B) Herniation h\u00e9patique dans le thorax<\/p><p>C) Pr\u00e9sence d\u2019un hydrops f\u0153tal<\/p><p>D) Position du foie sous-diaphragmatique<\/p><p>E) Ascite mod\u00e9r\u00e9e isol\u00e9e<\/p><\/li><\/ol><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><p><strong>A) LHR &lt; 1.0<\/strong><\/p><\/li><li><p><strong>B) Herniation h\u00e9patique dans le thorax<\/strong><\/p><\/li><li><p><strong>C) Pr\u00e9sence d\u2019un hydrops f\u0153tal<\/strong><\/p><\/li><\/ul><p><strong>Explication<\/strong> : Un <strong>LHR &lt; 1.0<\/strong> indique une <strong>hypoplasie pulmonaire s\u00e9v\u00e8re<\/strong>, tandis que la <strong>herniation h\u00e9patique<\/strong> et la pr\u00e9sence d\u2019un <strong>hydrops<\/strong> sont des <strong>facteurs p\u00e9joratifs<\/strong>. Une position h\u00e9patique normale et une ascite isol\u00e9e <strong>ne sont pas des marqueurs de gravit\u00e9<\/strong>.<\/p><p><strong><em>23 : Quelle est la prise en charge pr\u00e9natale possible d\u2019une HDC s\u00e9v\u00e8re ?<\/em><\/strong><\/p><ol><li><p>A) Surveillance \u00e9chographique rapproch\u00e9e<\/p><p>B) Pose d\u2019un shunt pleuro-amniotique<\/p><p>C) Occlusion trach\u00e9ale f\u0153toscopique (FETO)<\/p><p>D) C\u00e9sarienne obligatoire \u00e0 la naissance<\/p><p>E) Corticoth\u00e9rapie pr\u00e9natale pour la maturation pulmonaire<\/p><\/li><\/ol><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><p><strong>A) Surveillance \u00e9chographique rapproch\u00e9e<\/strong><\/p><\/li><li><p><strong>C) Occlusion trach\u00e9ale f\u0153toscopique (FETO)<\/strong><\/p><\/li><\/ul><p><strong>Explication<\/strong> : La <strong>surveillance \u00e9chographique<\/strong> est essentielle. La technique <strong>FETO<\/strong>, qui consiste \u00e0 <strong>obstruer temporairement la trach\u00e9e<\/strong> pour stimuler la croissance pulmonaire, peut \u00eatre propos\u00e9e dans les cas s\u00e9v\u00e8res. La <strong>c\u00e9sarienne n\u2019est pas syst\u00e9matique<\/strong>, et la corticoth\u00e9rapie n\u2019a <strong>pas d\u2019indication sp\u00e9cifique<\/strong> dans l\u2019HDC.<\/p><p><strong><em>\u00a0<\/em><\/strong><\/p><p><strong><em>24 : Que repr\u00e9sente cette s\u00e9rie d\u2019images en coupes axiales f\u0153tales ?<\/em><\/strong><\/p><p><a href=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-2-article-Prenatal-diagnosis-imaging-and-prognosis-in-Congenital-Diaphragmatic-Hernia.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-5101 aligncenter\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-2-article-Prenatal-diagnosis-imaging-and-prognosis-in-Congenital-Diaphragmatic-Hernia-300x287.jpg\" alt=\"\" width=\"300\" height=\"287\" srcset=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-2-article-Prenatal-diagnosis-imaging-and-prognosis-in-Congenital-Diaphragmatic-Hernia-300x287.jpg 300w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-2-article-Prenatal-diagnosis-imaging-and-prognosis-in-Congenital-Diaphragmatic-Hernia.jpg 700w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><\/p><ol><li><p>A) Une s\u00e9quence d\u2019imagerie de l\u2019abdomen f\u0153tal<\/p><p>B) Une \u00e9volution progressive d\u2019une hernie diaphragmatique cong\u00e9nitale (HDC)<\/p><p>C) Une classification des degr\u00e9s de s\u00e9v\u00e9rit\u00e9 de l\u2019HDC<\/p><p>D) Une comparaison entre une IRM f\u0153tale et une \u00e9chographie standard<\/p><p>E) Une analyse Doppler des flux sanguins pulmonaires<\/p><\/li><\/ol><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><p><strong>B) Une \u00e9volution progressive d\u2019une hernie diaphragmatique cong\u00e9nitale (HDC)<\/strong><\/p><\/li><li><p><strong>C) Une classification des degr\u00e9s de s\u00e9v\u00e9rit\u00e9 de l\u2019HDC<\/strong><\/p><\/li><\/ul><p><strong>Explication<\/strong> : Cette figure illustre diff\u00e9rents stades ou degr\u00e9s d\u2019<strong>engagement des organes abdominaux dans le thorax f\u0153tal<\/strong>, caract\u00e9ristiques d\u2019une <strong>HDC<\/strong>.<\/p><p><strong><em>\u00a0<\/em><\/strong><\/p><p><strong><em>25 : Quelles structures sont mises en \u00e9vidence par les couleurs sur ces images ?<\/em><\/strong><\/p><p><a href=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-2-article-Prenatal-diagnosis-imaging-and-prognosis-in-Congenital-Diaphragmatic-Hernia.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-5101 aligncenter\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-2-article-Prenatal-diagnosis-imaging-and-prognosis-in-Congenital-Diaphragmatic-Hernia-300x287.jpg\" alt=\"\" width=\"300\" height=\"287\" srcset=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-2-article-Prenatal-diagnosis-imaging-and-prognosis-in-Congenital-Diaphragmatic-Hernia-300x287.jpg 300w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-2-article-Prenatal-diagnosis-imaging-and-prognosis-in-Congenital-Diaphragmatic-Hernia.jpg 700w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><\/p><ol><li><p>A) Le foie en position intra-thoracique<\/p><p>B) Les poumons f\u0153taux<\/p><p>C) L\u2019intestin herni\u00e9<\/p><p>D) Le diaphragme en position normale<\/p><p>E) Le liquide amniotique<\/p><\/li><\/ol><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><p><strong>A) Le foie en position intra-thoracique<\/strong><\/p><\/li><li><p><strong>C) L\u2019intestin herni\u00e9<\/strong><\/p><\/li><\/ul><p><strong>Explication<\/strong> : La <strong>coloration<\/strong> met en \u00e9vidence les <strong>organes abdominaux d\u00e9plac\u00e9s dans le thorax<\/strong>, notamment le <strong>foie (en rouge)<\/strong> et l\u2019<strong>intestin (en blanc)<\/strong>, qui sont des marqueurs de s\u00e9v\u00e9rit\u00e9 de l\u2019HDC.<\/p><p><strong><em>26 : Quels crit\u00e8res permettent d\u2019\u00e9valuer la s\u00e9v\u00e9rit\u00e9 de l\u2019HDC ?<\/em><\/strong><\/p><ol><li><p>A) Le volume pulmonaire r\u00e9siduel<\/p><p>B) La position du foie (intra-thoracique ou non)<\/p><p>C) Le Lung-to-Head Ratio (LHR)<\/p><p>D) L\u2019\u00e9paisseur du diaphragme<\/p><p>E) La pr\u00e9sence d\u2019un hydramnios<\/p><\/li><\/ol><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><p><strong>A) Le volume pulmonaire r\u00e9siduel<\/strong><\/p><\/li><li><p><strong>B) La position du foie (intra-thoracique ou non)<\/strong><\/p><\/li><li><p><strong>C) Le Lung-to-Head Ratio (LHR)<\/strong><\/p><\/li><\/ul><p><strong>Explication<\/strong> : La s\u00e9v\u00e9rit\u00e9 de l\u2019HDC est d\u00e9termin\u00e9e par <strong>le volume pulmonaire restant<\/strong>, <strong>la herniation h\u00e9patique<\/strong> et <strong>le LHR<\/strong>, qui pr\u00e9dit le risque d\u2019hypoplasie pulmonaire.<\/p><p><strong><em>27 : Quelle est la valeur pronostique d\u2019une herniation h\u00e9patique dans l\u2019HDC ?<\/em><\/strong><\/p><ol><li><p>A) Elle est associ\u00e9e \u00e0 une hypoplasie pulmonaire plus s\u00e9v\u00e8re<\/p><p>B) Elle n\u2019a pas d\u2019impact sur le pronostic<\/p><p>C) Elle est associ\u00e9e \u00e0 un meilleur taux de survie n\u00e9onatale<\/p><p>D) Elle constitue une indication possible pour une occlusion trach\u00e9ale f\u0153toscopique (FETO)<\/p><p>E) Elle entra\u00eene une insuffisance h\u00e9patique f\u0153tale<\/p><\/li><\/ol><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><p><strong>A) Elle est associ\u00e9e \u00e0 une hypoplasie pulmonaire plus s\u00e9v\u00e8re<\/strong><\/p><\/li><li><p><strong>D) Elle constitue une indication possible pour une occlusion trach\u00e9ale f\u0153toscopique (FETO)<\/strong><\/p><\/li><\/ul><p><strong>Explication<\/strong> : La <strong>herniation h\u00e9patique<\/strong> est un facteur de <strong>mauvais pronostic<\/strong>, car elle r\u00e9duit le <strong>volume pulmonaire fonctionnel<\/strong>. Dans certains cas, une intervention <strong>FETO<\/strong> peut \u00eatre envisag\u00e9e pour am\u00e9liorer le d\u00e9veloppement pulmonaire in utero.<\/p><p><strong>\u00a0<\/strong><\/p><p><strong>\u00a0<\/strong><\/p><p><strong><em>28 : Quelle est (sont) l\u2019(les)anomalie(s) principale(s) visible(s) sur ces images \u00e9chographiques ?<\/em><\/strong><\/p><p><a href=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-3-article-Syndrome-de-Pallister-Killian-confrontation-des-donnees-prenatales-et-foetopathologiques-de-six-cas-et-revue-de-la-litterature.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\" wp-image-5102 aligncenter\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-3-article-Syndrome-de-Pallister-Killian-confrontation-des-donnees-prenatales-et-foetopathologiques-de-six-cas-et-revue-de-la-litterature-300x89.jpg\" alt=\"\" width=\"324\" height=\"96\" srcset=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-3-article-Syndrome-de-Pallister-Killian-confrontation-des-donnees-prenatales-et-foetopathologiques-de-six-cas-et-revue-de-la-litterature-300x89.jpg 300w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-3-article-Syndrome-de-Pallister-Killian-confrontation-des-donnees-prenatales-et-foetopathologiques-de-six-cas-et-revue-de-la-litterature.jpg 700w\" sizes=\"(max-width: 324px) 100vw, 324px\" \/><\/a><\/p><ol><li><p>A) Profil facial normal<\/p><p>B) Hypert\u00e9lorisme<\/p><p>C) Pro\u00e9minence frontale<\/p><p>D) Hypoplasie de la mandibule<\/p><p>E) Macroglossie<\/p><\/li><\/ol><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><p><strong>B) Hypert\u00e9lorisme<\/strong><\/p><\/li><li><p><strong>C) Pro\u00e9minence frontale<\/strong><\/p><\/li><li><p><strong>D) Hypoplasie de la mandibule<\/strong><\/p><\/li><\/ul><p><strong>Explication<\/strong> : Le syndrome de <strong>Pallister-Killian<\/strong> est caract\u00e9ris\u00e9 par des <strong>dysmorphies cranio-faciales<\/strong>, visibles ici en <strong>\u00e9chographie 2D et 3D<\/strong>. On observe un <strong>hypert\u00e9lorisme<\/strong>, une <strong>pro\u00e9minence du front<\/strong> et une <strong>hypoplasie mandibulaire<\/strong>.<\/p><p><strong><em>29 : Quels signes \u00e9chographiques peuvent \u00eatre associ\u00e9s au syndrome de Pallister-Killian ?<\/em><\/strong><\/p><ol><li><p>A) Polydactylie<\/p><p>B) Hydrops f\u0153tal<\/p><p>C) Anomalies c\u00e9r\u00e9brales (ventriculom\u00e9galie)<\/p><p>D) Anomalies diaphragmatique<\/p><p>E) Fentes palatines<\/p><\/li><\/ol><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><p><strong>B) Hydrops f\u0153tal<\/strong><\/p><\/li><li><p><strong>C) Anomalies c\u00e9r\u00e9brales (ventriculom\u00e9galie)<\/strong><\/p><\/li><li><p><strong>D) Anomalies diaphragmatique<\/strong><\/p><\/li><li><p><strong>E) Fentes palatines<\/strong><\/p><\/li><\/ul><p><strong>Explication<\/strong> : Le syndrome de <strong>Pallister-Killian<\/strong> peut \u00eatre associ\u00e9 \u00e0 un <strong>hydrops f\u0153tal<\/strong>, des <strong>malformations c\u00e9r\u00e9brales<\/strong>, des <strong>hernies diaphragmatiques<\/strong> et des <strong>anomalies faciales<\/strong> comme les <strong>fentes palatines<\/strong>. La polydactylie <strong>n\u2019est pas typique<\/strong> de ce syndrome.<\/p><p><strong><em>30 : Quelle est la cause g\u00e9n\u00e9tique du syndrome de Pallister-Killian ?<\/em><\/strong><\/p><ol><li><p>A) Trisomie 21 libre<\/p><p>B) Microd\u00e9l\u00e9tion 22q11<\/p><p>C) Tetrasomie en mosa\u00efque du chromosome 12p<\/p><p>D) Duplication du chromosome X<\/p><p>E) Mutation du g\u00e8ne FGFR2<\/p><\/li><\/ol><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><p><strong>C) Tetrasomie en mosa\u00efque du chromosome 12p<\/strong><\/p><\/li><\/ul><p><strong>Explication<\/strong> : Le syndrome de <strong>Pallister-Killian<\/strong> est caus\u00e9 par une <strong>tetrasomie en mosa\u00efque du chromosome 12p<\/strong>, d\u00e9tectable par <strong>FISH ou CGH-array<\/strong>, mais souvent <strong>absente en caryotype standard sur lymphocytes<\/strong>.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-91ebf94\" data-id=\"91ebf94\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-705714f elementor-widget elementor-widget-toggle\" data-id=\"705714f\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1171\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-1171\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">QCM 31-40<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1171\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-1171\"><p><strong><em>31 : Quel est l\u2019apport de l\u2019\u00e9chographie 3D dans l\u2019\u00e9valuation du syndrome de Pallister-Killian ?<\/em><\/strong><\/p><ol><li>A) Permet une meilleure visualisation des anomalies faciales<br \/>B) Remplace totalement l\u2019IRM c\u00e9r\u00e9brale<br \/>C) D\u00e9tecte les anomalies g\u00e9n\u00e9tiques<br \/>D) Am\u00e9liore le conseil pr\u00e9natal pour les parents<br \/>E) Permet une meilleure \u00e9valuation du volume pulmonaire<\/li><\/ol><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><strong>A) Permet une meilleure visualisation des anomalies faciales<\/strong><\/li><li><strong>D) Am\u00e9liore le conseil pr\u00e9natal pour les parents<\/strong><\/li><\/ul><p><strong>Explication<\/strong> : L\u2019<strong>\u00e9chographie 3D<\/strong> est particuli\u00e8rement utile pour <strong>visualiser les dysmorphies faciales<\/strong>, facilitant ainsi <strong>le diagnostic pr\u00e9natal et le conseil g\u00e9n\u00e9tique<\/strong>. Elle ne remplace pas l\u2019IRM, qui est essentielle pour l\u2019\u00e9valuation c\u00e9r\u00e9brale.<\/p><p><strong><em>32 : Quels signes \u00e9chographiques permettent de suspecter une HDC ?<\/em><\/strong><\/p><ol><li>A) D\u00e9placement du c\u0153ur vers le c\u00f4t\u00e9 oppos\u00e9<br \/>B) Visualisation de l\u2019estomac en position intra-thoracique<br \/>C) Hypoplasie pulmonaire du c\u00f4t\u00e9 atteint<br \/>D) \u00c9panchement pleural bilat\u00e9ral isol\u00e9<br \/>E) Pr\u00e9sence d\u2019une ascite mod\u00e9r\u00e9e<\/li><\/ol><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><strong>A) D\u00e9placement du c\u0153ur vers le c\u00f4t\u00e9 oppos\u00e9<\/strong><\/li><li><strong>B) Visualisation de l\u2019estomac en position intra-thoracique<\/strong><\/li><li><strong>C) Hypoplasie pulmonaire du c\u00f4t\u00e9 atteint<\/strong><\/li><\/ul><p><strong>Explication<\/strong> : L\u2019<strong>HDC<\/strong> entra\u00eene un <strong>d\u00e9placement du c\u0153ur<\/strong>, une <strong>herniation de l\u2019estomac et\/ou d\u2019anses intestinales dans le thorax<\/strong>, et une <strong>hypoplasie pulmonaire<\/strong>. L\u2019\u00e9panchement pleural et l\u2019ascite <strong>ne sont pas sp\u00e9cifiques<\/strong>.<\/p><p><strong><em>33 : Quelle est la m\u00e9thode utilis\u00e9e pour \u00e9valuer la s\u00e9v\u00e9rit\u00e9 d\u2019une HDC ?<\/em><\/strong><\/p><ol><li>A) Calcul du Lung-to-Head Ratio (LHR)<br \/>B) Doppler des art\u00e8res pulmonaires<br \/>C) Mesure du diam\u00e8tre abdominal<br \/>D) IRM pour estimer le volume pulmonaire<br \/>E) Caryotype f\u0153tal syst\u00e9matique<\/li><\/ol><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><strong>A) Calcul du Lung-to-Head Ratio (LHR)<\/strong><\/li><li><strong>D) IRM pour estimer le volume pulmonaire<\/strong><\/li><\/ul><p><strong>Explication<\/strong> : Le <strong>LHR<\/strong> permet d\u2019\u00e9valuer la <strong>capacit\u00e9 pulmonaire r\u00e9siduelle<\/strong>. L\u2019<strong>IRM f\u0153tale<\/strong> permet une analyse plus pr\u00e9cise du <strong>volume pulmonaire total<\/strong>. Le Doppler des art\u00e8res pulmonaires peut \u00eatre compl\u00e9mentaire, mais n\u2019est pas un crit\u00e8re principal.<\/p><p><strong><em>QCM 34 : Quels sont les facteurs \u00e9chographiques de mauvais pronostic en cas d\u2019HDC ?<\/em><\/strong><\/p><ol><li>A) LHR &lt; 1.0<br \/>B) Herniation h\u00e9patique intra-thoracique<br \/>C) Hydrops f\u0153tal<br \/>D) Position du foie sous-diaphragmatique<br \/>E) Absence de d\u00e9placement m\u00e9diastinal<\/li><\/ol><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><strong>A) LHR &lt; 1.0<\/strong><\/li><li><strong>B) Herniation h\u00e9patique intra-thoracique<\/strong><\/li><li><strong>C) Hydrops f\u0153tal<\/strong><\/li><\/ul><p><strong>Explication<\/strong> : Une <strong>herniation h\u00e9patique<\/strong>, un <strong>LHR bas<\/strong>, et un <strong>hydrops<\/strong> sont des <strong>marqueurs de mauvais pronostic<\/strong> car ils indiquent une <strong>hypoplasie pulmonaire s\u00e9v\u00e8re<\/strong> et un <strong>risque de d\u00e9tresse respiratoire n\u00e9onatale<\/strong>.<\/p><p><strong><em>QCM 35 : Quelle est la prise en charge pr\u00e9natale recommand\u00e9e pour une HDC s\u00e9v\u00e8re ?<\/em><\/strong><\/p><ol><li>A) Surveillance \u00e9chographique rapproch\u00e9e<br \/>B) Occlusion trach\u00e9ale f\u0153toscopique (FETO)<br \/>C) C\u00e9sarienne obligatoire \u00e0 la naissance<br \/>D) Corticoth\u00e9rapie pour maturation pulmonaire<br \/>E) Interruption m\u00e9dicale de grossesse syst\u00e9matique<\/li><\/ol><p>\u2705 <strong>R\u00e9ponse(s) correcte(s) :<\/strong><\/p><ul><li><strong>A) Surveillance \u00e9chographique rapproch\u00e9e<\/strong><\/li><li><strong>B) Occlusion trach\u00e9ale f\u0153toscopique (FETO)<\/strong><\/li><\/ul><p><strong>Explication<\/strong> : La <strong>surveillance \u00e9chographique<\/strong> est essentielle. Pour les formes <strong>s\u00e9v\u00e8res (LHR &lt; 1.0, hernie h\u00e9patique)<\/strong>, une intervention <strong>FETO<\/strong> peut \u00eatre indiqu\u00e9e pour am\u00e9liorer la <strong>croissance pulmonaire<\/strong>. La c\u00e9sarienne <strong>n\u2019est pas syst\u00e9matique<\/strong>, et la corticoth\u00e9rapie n\u2019a pas de <strong>preuve d\u2019efficacit\u00e9 sp\u00e9cifique<\/strong> pour l\u2019HDC.<\/p><p><strong>\u00a0<\/strong><strong><em>36 : Quel(s) \u00e9l\u00e9ment(s) de cette image \u00e9voque(nt) un hydrothorax bilat\u00e9ral ?<\/em><\/strong><\/p><p><a href=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.3-du-Chapitre-18-Thorax-livre-Gilles-Grange.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-5109 aligncenter\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.3-du-Chapitre-18-Thorax-livre-Gilles-Grange-300x272.jpg\" alt=\"\" width=\"300\" height=\"272\" srcset=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.3-du-Chapitre-18-Thorax-livre-Gilles-Grange-300x272.jpg 300w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.3-du-Chapitre-18-Thorax-livre-Gilles-Grange.jpg 700w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><\/p><ol><li><br \/>\u00c9panchement pleural an\u00e9chog\u00e8ne autour des poumons<br \/>B. D\u00e9placement du c\u0153ur en position centrale<br \/>C. Pr\u00e9sence d\u2019une masse solide intrathoracique<br \/>D. Visualisation de cloisons \u00e9paisses dans l\u2019\u00e9panchement<br \/>E. Hyper\u00e9chog\u00e9nicit\u00e9 diffuse du parenchyme pulmonaire<\/li><\/ol><p>\u2705 <strong>R\u00e9ponses exactes : A et B<\/strong><br \/>\u27a1 <strong>Explication :<\/strong> L\u2019hydrothorax se manifeste par un <strong>\u00e9panchement pleural an\u00e9chog\u00e8ne<\/strong>, ce qui est visible sur l\u2019image. Si l\u2019\u00e9panchement est important, il peut provoquer un <strong>d\u00e9placement du c\u0153ur<\/strong> vers le centre ou le c\u00f4t\u00e9 oppos\u00e9.<\/p><p><strong><em>37 : Quelle(s) pathologie(s) peut\/peuvent \u00eatre associ\u00e9e(s) \u00e0 un hydrothorax f\u0153tal ?<\/em><\/strong><\/p><ol><li><br \/>Chylothorax cong\u00e9nital<br \/>B. Hydrops f\u0153tal<br \/>C. S\u00e9quence d\u2019obstruction bronchique<br \/>D. Hernie diaphragmatique<br \/>E. Dysplasie bronchopulmonaire<\/li><\/ol><p>\u2705 <strong>R\u00e9ponses exactes : A, B et D<\/strong><br \/>\u27a1 <strong>Explication :<\/strong><\/p><ul><li>Le <strong>chylothorax cong\u00e9nital<\/strong> est une cause fr\u00e9quente d\u2019hydrothorax, li\u00e9 \u00e0 une fuite de lymphe dans la cavit\u00e9 pleurale.<\/li><li>L\u2019<strong>hydrops f\u0153tal<\/strong>, secondaire \u00e0 une insuffisance cardiaque ou une an\u00e9mie s\u00e9v\u00e8re, entra\u00eene un \u00e9panchement pleural par augmentation de la pression hydrostatique.<\/li><li>Une <strong>hernie diaphragmatique<\/strong> peut \u00eatre associ\u00e9e \u00e0 un \u00e9panchement pleural en raison d\u2019une compression pulmonaire.<\/li><li>La <strong>s\u00e9quence d\u2019obstruction bronchique<\/strong> est plut\u00f4t responsable d\u2019une hyperinflation pulmonaire, et la <strong>dysplasie bronchopulmonaire<\/strong> est une complication postnatale, non une cause d\u2019hydrothorax pr\u00e9natal.<\/li><\/ul><p><strong><em>38 : Quel(s) impact(s) peut avoir un hydrothorax bilat\u00e9ral sur le d\u00e9veloppement f\u0153tal ?<\/em><\/strong><\/p><ol><li><br \/>Hypoplasie pulmonaire<br \/>B. Compression cardiaque avec insuffisance cardiaque<br \/>C. Ascite et anasarque f\u0153tale<br \/>D. Oligoamnios s\u00e9v\u00e8re<br \/>E. Compression de l\u2019\u0153sophage entra\u00eenant une polyhydramnios<\/li><\/ol><p>\u2705 <strong>R\u00e9ponses exactes : A, B, C et E<\/strong><br \/>\u27a1 <strong>Explication :<\/strong><\/p><ul><li>L\u2019<strong>hypoplasie pulmonaire<\/strong> est une complication fr\u00e9quente due \u00e0 la compression des poumons par l\u2019\u00e9panchement pleural.<\/li><li>Une <strong>compression cardiaque<\/strong> peut entra\u00eener une insuffisance cardiaque f\u0153tale, favorisant un <strong>hydrops<\/strong>.<\/li><li>L\u2019<strong>anasarque f\u0153tale<\/strong> peut \u00eatre la cons\u00e9quence d\u2019une insuffisance cardiaque droite secondaire.<\/li><li>Un <strong>polyhydramnios<\/strong> peut appara\u00eetre en cas de compression de l\u2019\u0153sophage par un m\u00e9diastin refoul\u00e9, limitant la d\u00e9glutition f\u0153tale.<\/li><li>En revanche, un <strong>oligoamnios<\/strong> est plus fr\u00e9quemment associ\u00e9 \u00e0 une pathologie r\u00e9nale ou \u00e0 une rupture pr\u00e9matur\u00e9e des membranes.<\/li><\/ul><p>\u00a0<\/p><p><strong><em>39 : Quel(s) traitement(s) peut\/peuvent \u00eatre envisag\u00e9(s) en cas d\u2019hydrothorax bilat\u00e9ral symptomatique ?<\/em><\/strong><\/p><ol><li><br \/>Ponction pleurale f\u0153tale sous contr\u00f4le \u00e9chographique<br \/>B. Pose d\u2019un shunt pleuro-amniotique<br \/>C. Administration intra-ut\u00e9rine d\u2019antibiotiques<br \/>D. Corticoth\u00e9rapie maternelle<br \/>E. F\u0153toscopie interventionnelle pour drainage bronchique<\/li><\/ol><p>\u2705 <strong>R\u00e9ponses exactes : A, B et D<\/strong><br \/>\u27a1 <strong>Explication :<\/strong><\/p><ul><li>Une <strong>ponction pleurale<\/strong> est indiqu\u00e9e en cas d\u2019\u00e9panchement volumineux mena\u00e7ant la fonction cardiorespiratoire.<\/li><li>Un <strong>shunt pleuro-amniotique<\/strong> permet un drainage continu et est recommand\u00e9 dans les formes s\u00e9v\u00e8res.<\/li><li>Une <strong>corticoth\u00e9rapie maternelle<\/strong> est indiqu\u00e9e si un accouchement pr\u00e9matur\u00e9 est pr\u00e9vu, pour favoriser la maturation pulmonaire.<\/li><li>L\u2019<strong>administration intra-ut\u00e9rine d\u2019antibiotiques<\/strong> n\u2019est pas justifi\u00e9e car l\u2019hydrothorax n\u2019est pas d\u2019origine infectieuse.<\/li><li>Une <strong>f\u0153toscopie interventionnelle<\/strong> est utilis\u00e9e pour certaines pathologies obstructives mais <strong>pas pour l\u2019hydrothorax<\/strong>.<\/li><\/ul><p><strong><em>40 : Quel(s) \u00e9l\u00e9ment(s) de cette image \u00e9voque(nt) un hydrothorax unilat\u00e9ral ?<\/em><\/strong><\/p><p><a href=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.4-du-Chapitre-18-Thorax-livre-Gilles-Grange.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-5110 aligncenter\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.4-du-Chapitre-18-Thorax-livre-Gilles-Grange-300x238.jpg\" alt=\"\" width=\"300\" height=\"238\" srcset=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.4-du-Chapitre-18-Thorax-livre-Gilles-Grange-300x238.jpg 300w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.4-du-Chapitre-18-Thorax-livre-Gilles-Grange.jpg 700w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><\/p><p>\u00a0<\/p><ol><li><br \/>Pr\u00e9sence d\u2019un \u00e9panchement pleural an\u00e9chog\u00e8ne<br \/>B. D\u00e9viation du c\u0153ur vers le c\u00f4t\u00e9 oppos\u00e9<br \/>C. Cloisons \u00e9paisses visibles dans le liquide pleural<br \/>D. Hyper\u00e9chog\u00e9nicit\u00e9 pulmonaire homog\u00e8ne<br \/>E. Pr\u00e9sence d\u2019un arc vasculaire anormal<\/li><\/ol><p>\u2705 <strong>R\u00e9ponses exactes : A et B<\/strong><br \/>\u27a1 <strong>Explication :<\/strong> L\u2019hydrothorax unilat\u00e9ral est caract\u00e9ris\u00e9 par <strong>un \u00e9panchement pleural an\u00e9chog\u00e8ne<\/strong>, visible sur cette coupe axiale. Si l\u2019\u00e9panchement est important, il peut provoquer une <strong>d\u00e9viation du c\u0153ur<\/strong> vers le c\u00f4t\u00e9 oppos\u00e9. La pr\u00e9sence de <strong>cloisons \u00e9paisses<\/strong> est atypique et peut sugg\u00e9rer une infection ou un \u00e9panchement organis\u00e9. Une hyper\u00e9chog\u00e9nicit\u00e9 homog\u00e8ne du parenchyme pulmonaire n\u2019est pas un signe caract\u00e9ristique de l\u2019hydrothorax. L\u2019<strong>identification d\u2019un arc vasculaire anormal<\/strong> pourrait \u00e9voquer une <strong>s\u00e9questration pulmonaire<\/strong>, ce qui n\u2019est pas le cas ici.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1172\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-1172\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">QCM 41-50<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1172\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-1172\"><p><strong><em>41 : Parmi les diagnostics diff\u00e9rentiels de l\u2019hydrothorax f\u0153tal unilat\u00e9ral, lequel (lesquels) peut (peuvent) \u00eatre envisag\u00e9(s) ?<\/em><\/strong><\/p><ol><li><br \/>S\u00e9questration pulmonaire<br \/>B. Hernie diaphragmatique cong\u00e9nitale<br \/>C. Malformation ad\u00e9nomato\u00efde kystique cong\u00e9nitale (CCAM)<br \/>D. Atr\u00e9sie bronchique<br \/>E. Fibrose kystique<\/li><\/ol><p>\u2705 <strong>R\u00e9ponses exactes : A, B, C et D<\/strong><br \/>\u27a1 <strong>Explication :<\/strong><\/p><ul><li>La <strong>s\u00e9questration pulmonaire<\/strong> peut se pr\u00e9senter sous forme d\u2019une masse hyperechog\u00e8ne associ\u00e9e \u00e0 un \u00e9panchement pleural.<\/li><li>La <strong>hernie diaphragmatique<\/strong> peut entra\u00eener une accumulation de liquide dans le thorax en raison d\u2019une compression pulmonaire.<\/li><li>Une <strong>malformation ad\u00e9nomato\u00efde kystique cong\u00e9nitale (CCAM)<\/strong> peut \u00eatre associ\u00e9e \u00e0 un \u00e9panchement pleural dans certaines formes macro-kystiques.<\/li><li>Une <strong>atr\u00e9sie bronchique<\/strong> entra\u00eene une distension pulmonaire qui peut s&#8217;accompagner d\u2019un \u00e9panchement pleural secondaire.<\/li><li>La <strong>fibrose kystique<\/strong> n\u2019est pas un diagnostic diff\u00e9rentiel pr\u00e9natal de l\u2019hydrothorax.<\/li><\/ul><p><strong><em>42 : Quelle(s) \u00e9volution(s) possible(s) peut\/peuvent \u00eatre observ\u00e9e(s) en cas d\u2019hydrothorax unilat\u00e9ral ?<\/em><\/strong><\/p><ol><li><br \/>R\u00e9sorption spontan\u00e9e<br \/>B. Progression vers un hydrothorax bilat\u00e9ral<br \/>C. D\u00e9veloppement d\u2019un hydrops f\u0153tal<br \/>D. Apparition d\u2019une ascite secondaire<br \/>E. Obstruction compl\u00e8te des bronches<\/li><\/ol><p>\u2705 <strong>R\u00e9ponses exactes : A, B, C et D<\/strong><br \/>\u27a1 <strong>Explication :<\/strong><\/p><ul><li>L\u2019hydrothorax f\u0153tal peut <strong>se r\u00e9sorber spontan\u00e9ment<\/strong> dans certains cas b\u00e9nins.<\/li><li>Il peut \u00e9galement <strong>progresser vers un hydrothorax bilat\u00e9ral<\/strong>, notamment en cas de dysfonction lymphatique persistante.<\/li><li>Dans les formes s\u00e9v\u00e8res, il peut \u00e9voluer vers un <strong>hydrops f\u0153tal<\/strong> par insuffisance cardiaque droite.<\/li><li>Une <strong>ascite secondaire<\/strong> peut appara\u00eetre en raison d\u2019une hypoalbumin\u00e9mie ou d\u2019une hypertension veineuse.<\/li><li>Une <strong>obstruction bronchique compl\u00e8te<\/strong> n\u2019est pas une cons\u00e9quence directe d\u2019un hydrothorax.<\/li><\/ul><p><strong><em>43 : Dans quelle(s) situation(s) un shunt pleuro-amniotique est-il indiqu\u00e9 pour traiter un hydrothorax unilat\u00e9ral ?<\/em><\/strong><\/p><ol><li><br \/>\u00c9panchement pleural massif entra\u00eenant une hypoplasie pulmonaire<br \/>B. Hydrops f\u0153tal secondaire \u00e0 l\u2019\u00e9panchement pleural<br \/>C. \u00c9panchement unilat\u00e9ral mod\u00e9r\u00e9 et stable<br \/>D. Pr\u00e9sence de cloisons multiples dans l\u2019\u00e9panchement<br \/>E. \u00c9panchement pleural associ\u00e9 \u00e0 une hernie diaphragmatique<\/li><\/ol><p>\u2705 <strong>R\u00e9ponses exactes : A et B<\/strong><br \/>\u27a1 <strong>Explication :<\/strong><\/p><ul><li>Un shunt pleuro-amniotique est indiqu\u00e9 en cas d\u2019<strong>\u00e9panchement pleural massif<\/strong> qui compromet la fonction pulmonaire et cardiaque.<\/li><li>Il est \u00e9galement indiqu\u00e9 en pr\u00e9sence d\u2019un <strong>hydrops f\u0153tal secondaire<\/strong> pour tenter d\u2019am\u00e9liorer l\u2019h\u00e9modynamique f\u0153tale.<\/li><li>Un \u00e9panchement mod\u00e9r\u00e9 et stable ne justifie pas d\u2019intervention invasive.<\/li><li>La pr\u00e9sence de <strong>cloisons multiples<\/strong> sugg\u00e8re une infection ou un processus tumoral, et peut limiter l\u2019efficacit\u00e9 du shunt.<\/li><li>Un <strong>\u00e9panchement associ\u00e9 \u00e0 une hernie diaphragmatique<\/strong> n\u00e9cessite une prise en charge sp\u00e9cifique avant de poser un shunt.<\/li><\/ul><p><strong><em>44 : Quel(s) \u00e9l\u00e9ment(s) doit\/doivent \u00eatre surveill\u00e9(s) chez un nouveau-n\u00e9 ayant eu un hydrothorax f\u0153tal ?<\/em><\/strong><\/p><ol><li><br \/>Fonction respiratoire et signes d\u2019hypoplasie pulmonaire<br \/>B. Persistance d\u2019un \u00e9panchement pleural \u00e0 la naissance<br \/>C. \u00c9valuation de la fonction cardiaque<br \/>D. Risque de complications infectieuses pulmonaires<br \/>E. \u00c9valuation du d\u00e9veloppement neurologique<\/li><\/ol><p>\u2705 <strong>R\u00e9ponses exactes : A, B, C et D<\/strong><br \/>\u27a1 <strong>Explication :<\/strong><\/p><ul><li>La <strong>fonction respiratoire<\/strong> doit \u00eatre \u00e9valu\u00e9e car une hypoplasie pulmonaire peut entra\u00eener une d\u00e9tresse respiratoire n\u00e9onatale.<\/li><li>Une <strong>persistance de l\u2019\u00e9panchement pleural<\/strong> n\u00e9cessite une surveillance et parfois un drainage postnatal.<\/li><li>Une <strong>\u00e9valuation cardiaque<\/strong> est importante, notamment si l\u2019\u00e9panchement \u00e9tait associ\u00e9 \u00e0 une compression m\u00e9diastinale.<\/li><li>Un <strong>risque infectieux pulmonaire<\/strong> existe en cas de drainage pleural ou de pneumopathie associ\u00e9e.<\/li><li>Le <strong>d\u00e9veloppement neurologique<\/strong> n\u2019est pas directement li\u00e9 \u00e0 l\u2019hydrothorax, sauf en cas d\u2019hypoxie s\u00e9v\u00e8re prolong\u00e9e.<\/li><\/ul><p><strong><em>45 : Diagnostic \u00e9chographique de l\u2019anomalie observ\u00e9e. <\/em><\/strong><strong><em>Que met en \u00e9vidence cette image \u00e9chographique ?<\/em><\/strong><\/p><p><a href=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.13-du-Chapitre-18-Thorax-livre-Gilles-Grange.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-5117 aligncenter\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.13-du-Chapitre-18-Thorax-livre-Gilles-Grange-300x269.jpg\" alt=\"\" width=\"300\" height=\"269\" srcset=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.13-du-Chapitre-18-Thorax-livre-Gilles-Grange-300x269.jpg 300w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.13-du-Chapitre-18-Thorax-livre-Gilles-Grange.jpg 660w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><br \/>A. Une masse pulmonaire hyper\u00e9chog\u00e8ne<br \/>B. Une structure kystique macrokystique<br \/>C. Une d\u00e9viation du diaphragme<br \/>D. Un \u00e9panchement pleural<br \/>E. Une vascularisation syst\u00e9mique anormale<\/p><p>\u2705 <strong>R\u00e9ponses exactes : A, B et C<\/strong><br \/>\u27a1 <strong>Explication :<\/strong><\/p><ul><li>Cette image illustre une <strong>maladie ad\u00e9nomato\u00efde kystique pulmonaire (MAKP) droite macrokystique<\/strong>, caract\u00e9ris\u00e9e par la pr\u00e9sence de <strong>kystes an\u00e9chog\u00e8nes<\/strong> au sein d\u2019une masse pulmonaire hyper\u00e9chog\u00e8ne.<\/li><li>Une <strong>d\u00e9viation du diaphragme<\/strong> est observ\u00e9e, due \u00e0 l\u2019effet de masse de la l\u00e9sion.<\/li><li>Un <strong>\u00e9panchement pleural<\/strong> peut \u00eatre associ\u00e9, mais il n&#8217;est pas visible ici.<\/li><\/ul><p><strong><em>46 : <\/em><\/strong><strong><em>Quelle(s) complication(s) peut\/peuvent survenir en cas de MAKP volumineuse ?<\/em><\/strong><\/p><p><strong><br \/><\/strong>A. Hypoplasie pulmonaire<br \/>B. Hydrops f\u0153tal<br \/>C. Insuffisance cardiaque f\u0153tale<br \/>D. R\u00e9gression spontan\u00e9e au troisi\u00e8me trimestre<br \/>E. Compression de la trach\u00e9e entra\u00eenant une obstruction compl\u00e8te des voies a\u00e9riennes<\/p><p>\u2705 <strong>R\u00e9ponses exactes : A, B, C et D<\/strong><br \/>\u27a1 <strong>Explication :<\/strong><\/p><ul><li>Une <strong>hypoplasie pulmonaire<\/strong> est fr\u00e9quente lorsque la masse pulmonaire compresse le poumon controlat\u00e9ral.<\/li><li>Un <strong>hydrops f\u0153tal<\/strong> peut survenir si l\u2019effet de masse entra\u00eene une obstruction du retour veineux cave ou une compression cardiaque.<\/li><li>Une <strong>insuffisance cardiaque f\u0153tale<\/strong> peut appara\u00eetre dans les cas s\u00e9v\u00e8res, n\u00e9cessitant une intervention pr\u00e9natale.<\/li><li>Dans certains cas, une <strong>r\u00e9gression spontan\u00e9e<\/strong> est observ\u00e9e au troisi\u00e8me trimestre, avec une diminution relative de la taille de la masse.<\/li><li>Une <strong>compression trach\u00e9ale s\u00e9v\u00e8re<\/strong> est rare avec la MAKP, contrairement \u00e0 certaines <strong>atr\u00e9sies laryng\u00e9es<\/strong>.<\/li><\/ul><p><strong><em>47 : <\/em><\/strong><strong><em>Quelle(s) approche(s) th\u00e9rapeutique(s) peut\/peuvent \u00eatre envisag\u00e9e(s) dans la prise en charge d\u2019une MAKP volumineuse avec retentissement f\u0153tal ?<\/em><\/strong><\/p><p><strong><br \/><\/strong>A. Surveillance \u00e9chographique rapproch\u00e9e<br \/>B. Ponction ou drainage in utero des kystes volumineux<br \/>C. Administration maternelle de cortico\u00efdes en cas de risque d\u2019accouchement pr\u00e9matur\u00e9<br \/>D. Ex\u00e9r\u00e8se chirurgicale postnatale en cas de persistance symptomatique<br \/>E. Embolisation des vaisseaux irriguant la masse<\/p><p>\u2705 <strong>R\u00e9ponses exactes : A, B, C et D<\/strong><br \/>\u27a1 <strong>Explication :<\/strong><\/p><ul><li>Une <strong>surveillance \u00e9chographique rapproch\u00e9e<\/strong> est n\u00e9cessaire pour suivre l\u2019\u00e9volution de la l\u00e9sion et d\u00e9tecter d\u2019\u00e9ventuelles complications.<\/li><li>Un <strong>drainage in utero<\/strong> peut \u00eatre envisag\u00e9 pour les <strong>formes macrokystiques compressives<\/strong> afin de soulager la compression m\u00e9diastinale.<\/li><li>Une <strong>corticoth\u00e9rapie maternelle<\/strong> est recommand\u00e9e si un accouchement pr\u00e9matur\u00e9 est probable, afin d\u2019am\u00e9liorer la maturation pulmonaire.<\/li><li>Une <strong>ex\u00e9r\u00e8se chirurgicale postnatale<\/strong> est indiqu\u00e9e en cas de persistance de la l\u00e9sion et de g\u00eane respiratoire n\u00e9onatale.<\/li><li>L\u2019<strong>embolisation des vaisseaux<\/strong> n\u2019a pas d\u2019indication ici, car la MAKP n\u2019a pas de vascularisation syst\u00e9mique aberrante contrairement \u00e0 une s\u00e9questration pulmonaire.<\/li><\/ul><p><strong><em>48 : Que montre cette image \u00e9chographique ?<\/em><\/strong><\/p><p><a href=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.12-du-Chapitre-18-Thorax-livre-Gilles-Grange-CORR.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-5118 aligncenter\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.12-du-Chapitre-18-Thorax-livre-Gilles-Grange-CORR-239x300.jpg\" alt=\"\" width=\"239\" height=\"300\" srcset=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.12-du-Chapitre-18-Thorax-livre-Gilles-Grange-CORR-239x300.jpg 239w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.12-du-Chapitre-18-Thorax-livre-Gilles-Grange-CORR-815x1024.jpg 815w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.12-du-Chapitre-18-Thorax-livre-Gilles-Grange-CORR-768x965.jpg 768w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.12-du-Chapitre-18-Thorax-livre-Gilles-Grange-CORR.jpg 1114w\" sizes=\"(max-width: 239px) 100vw, 239px\" \/><\/a><\/p><ol><li><br \/>Une malformation ad\u00e9nomato\u00efde kystique pulmonaire (MAKP) microkystique<br \/>B. Un \u00e9panchement pleural an\u00e9chog\u00e8ne<br \/>C. Une s\u00e9questration pulmonaire<br \/>D. Un hydrops f\u0153tal<br \/>E. Une hernie diaphragmatique<\/li><\/ol><p>\u2705 <strong>R\u00e9ponses exactes : A et D<\/strong><br \/>\u27a1 <strong>Explication :<\/strong><\/p><ul><li>Cette image illustre une <strong>maladie ad\u00e9nomato\u00efde kystique pulmonaire (MAKP) microkystique<\/strong>, caract\u00e9ris\u00e9e par une structure pulmonaire <strong>hyper\u00e9chog\u00e8ne<\/strong>, sans kystes macrokystiques visibles.<\/li><li>Un <strong>hydrops f\u0153tal<\/strong> est pr\u00e9sent, comme le sugg\u00e8re l\u2019<strong>\u0153d\u00e8me sous-cutan\u00e9<\/strong> visible (fl\u00e8che noire)<\/li><li>Il n\u2019y a <strong>pas d\u2019\u00e9panchement pleural an\u00e9chog\u00e8ne<\/strong> ici, mais la MAKP peut parfois s\u2019accompagner d\u2019un hydrothorax.<\/li><li>Une <strong>s\u00e9questration pulmonaire<\/strong> pr\u00e9sente g\u00e9n\u00e9ralement une vascularisation syst\u00e9mique anormale, absente ici.<\/li><li>Il ne s\u2019agit pas d\u2019une <strong>hernie diaphragmatique<\/strong>, car on ne voit pas de structures abdominales dans le thorax.<\/li><\/ul><p>\u00a0<\/p><p><strong><em>49 : Quelle(s) complication(s) peut\/peuvent survenir en cas de MAKP microkystique volumineuse ?<\/em><\/strong><\/p><ol><li><br \/>Hypoplasie pulmonaire<br \/>B. Hydrops f\u0153tal<br \/>C. Compression cardiaque avec d\u00e9viation m\u00e9diastinale<br \/>D. R\u00e9gression spontan\u00e9e au troisi\u00e8me trimestre<br \/>E. Obstruction trach\u00e9ale compl\u00e8te<\/li><\/ol><p>\u2705 <strong>R\u00e9ponses exactes : A, B, C et D<\/strong><br \/>\u27a1 <strong>Explication :<\/strong><\/p><ul><li>Une <strong>hypoplasie pulmonaire<\/strong> peut survenir si la masse emp\u00eache le d\u00e9veloppement normal du poumon controlat\u00e9ral.<\/li><li>Un <strong>hydrops f\u0153tal<\/strong> peut appara\u00eetre lorsque la compression thoracique entra\u00eene une insuffisance cardiaque et un \u0153d\u00e8me g\u00e9n\u00e9ralis\u00e9.<\/li><li>Une <strong>d\u00e9viation m\u00e9diastinale<\/strong> est visible sur l\u2019image, provoqu\u00e9e par l\u2019effet de masse de la MAKP sur le c\u0153ur.<\/li><li>Dans certains cas, une <strong>r\u00e9gression spontan\u00e9e<\/strong> de la MAKP est observ\u00e9e en fin de grossesse.<\/li><li>Une <strong>obstruction trach\u00e9ale compl\u00e8te<\/strong> n\u2019est pas une cons\u00e9quence habituelle de la MAKP microkystique.<\/li><\/ul><p>\u00a0<\/p><p><strong><em>50 : Dans quel(s) cas un drainage in utero peut-il \u00eatre indiqu\u00e9 pour cette pathologie ?<\/em><\/strong><\/p><ol><li><br \/>Pr\u00e9sence d\u2019un kyste unique de plus de 2 cm<br \/>B. Apparition d\u2019un hydrops f\u0153tal<br \/>C. D\u00e9placement majeur du c\u0153ur avec compression cardiaque<br \/>D. Oligoamnios s\u00e9v\u00e8re<br \/>E. Suspection d\u2019une infection intra-ut\u00e9rine associ\u00e9e<\/li><\/ol><p>\u2705 <strong>R\u00e9ponses exactes : B et C<\/strong><br \/>\u27a1 <strong>Explication :<\/strong><\/p><ul><li>Un <strong>hydrops f\u0153tal<\/strong> justifie souvent une intervention f\u0153tale pour diminuer la pression thoracique.<\/li><li>Une <strong>compression cardiaque majeure<\/strong> peut n\u00e9cessiter un drainage in utero pour \u00e9viter une insuffisance cardiaque f\u0153tale.<\/li><li>Un <strong>kyste unique de plus de 2 cm<\/strong> peut \u00eatre drain\u00e9 dans les formes macrokystiques, mais la MAKP ici est <strong>microkystique<\/strong>, donc ce crit\u00e8re ne s\u2019applique pas.<\/li><li>Un <strong>oligoamnios s\u00e9v\u00e8re<\/strong> n\u2019est pas une indication sp\u00e9cifique de drainage pulmonaire.<\/li><li>Une <strong>infection intra-ut\u00e9rine<\/strong> rel\u00e8ve d\u2019une autre prise en charge.<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1173\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-1173\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">QCM 51-55<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1173\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-1173\"><p><strong><em>51 : \u00a0Quelle(s) prise(s) en charge est(sont) recommand\u00e9e(s) apr\u00e8s la naissance pour un nouveau-n\u00e9 ayant eu une MAKP microkystique avec hydrops ?<\/em><\/strong><\/p><ol><li><strong><br \/><\/strong> Intubation et assistance ventilatoire en cas de d\u00e9tresse respiratoire<br \/>B. R\u00e9section chirurgicale de la l\u00e9sion si symptomatique<br \/>C. Surveillance \u00e9chographique pulmonaire durant les premiers mois<br \/>D. Traitement par antibiotiques syst\u00e9matiques<br \/>E. Drainage postnatal imm\u00e9diat du poumon atteint<\/li><\/ol><p>\u2705 <strong>R\u00e9ponses exactes : A, B et C<\/strong><br \/>\u27a1 <strong>Explication :<\/strong><\/p><ul><li>Un nouveau-n\u00e9 avec MAKP volumineuse peut pr\u00e9senter une <strong>d\u00e9tresse respiratoire n\u00e9cessitant une intubation<\/strong>.<\/li><li>Une <strong>r\u00e9section chirurgicale<\/strong> est indiqu\u00e9e si la l\u00e9sion persiste et entra\u00eene des sympt\u00f4mes respiratoires.<\/li><li>Une <strong>surveillance \u00e9chographique<\/strong> permet d\u2019\u00e9valuer l\u2019\u00e9volution de la l\u00e9sion apr\u00e8s la naissance.<\/li><li>Une <strong>antibioth\u00e9rapie syst\u00e9matique<\/strong> n\u2019est pas indiqu\u00e9e en l\u2019absence d\u2019infection.<\/li><li>Un <strong>drainage pulmonaire postnatal imm\u00e9diat<\/strong> n\u2019est pas syst\u00e9matique pour une MAKP microkystique, sauf en cas de complications.<\/li><\/ul><p><strong><em>52 : \u00a0Que montre cette image \u00e9chographique ?<\/em><\/strong><\/p><p><a href=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.15-du-Chapitre-18-Thorax-livre-Gilles-Grange.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-5122 aligncenter\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.15-du-Chapitre-18-Thorax-livre-Gilles-Grange-300x214.jpg\" alt=\"\" width=\"300\" height=\"214\" srcset=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.15-du-Chapitre-18-Thorax-livre-Gilles-Grange-300x214.jpg 300w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.15-du-Chapitre-18-Thorax-livre-Gilles-Grange-1024x729.jpg 1024w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.15-du-Chapitre-18-Thorax-livre-Gilles-Grange-768x547.jpg 768w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.15-du-Chapitre-18-Thorax-livre-Gilles-Grange.jpg 1095w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><\/a><\/p><ol><li><br \/>Une s\u00e9questration pulmonaire<br \/>B. Une malformation ad\u00e9nomato\u00efde kystique pulmonaire (MAKP)<br \/>C. Une hernie diaphragmatique<br \/>D. Une duplication \u0153sophagienne<br \/>E. Un hydrothorax<\/li><\/ol><p>\u2705 <strong>R\u00e9ponses exactes : A<\/strong><br \/>\u27a1 <strong>Explication :<\/strong><\/p><ul><li>Cette image met en \u00e9vidence une <strong>s\u00e9questration pulmonaire<\/strong>, caract\u00e9ris\u00e9e par une masse <strong>hyper\u00e9chog\u00e8ne bien limit\u00e9e<\/strong>.<\/li><li>La <strong>vascularisation syst\u00e9mique<\/strong> de la masse est d\u00e9montr\u00e9e en Doppler couleur, avec une <strong>art\u00e8re nourrici\u00e8re issue de l\u2019aorte<\/strong> (fl\u00e8ches noires), ce qui confirme le diagnostic.<\/li><li>Contrairement \u00e0 la <strong>MAKP<\/strong>, la s\u00e9questration pulmonaire ne communique pas avec les bronches et a une vascularisation <strong>syst\u00e9mique<\/strong> et non pulmonaire.<\/li><li>Il n\u2019y a pas de <strong>contenu digestif intra-thoracique<\/strong> permettant d\u2019\u00e9voquer une hernie diaphragmatique.<\/li><li>Une <strong>duplication \u0153sophagienne<\/strong> se pr\u00e9sente g\u00e9n\u00e9ralement comme une <strong>structure kystique post\u00e9rieure<\/strong>, ce qui n\u2019est pas le cas ici.<\/li><li>Aucun <strong>\u00e9panchement pleural<\/strong> n\u2019est visible sur cette image.<\/li><\/ul><p><strong>\u00a0<\/strong><strong><em>53 : Caract\u00e9ristiques \u00e9chographiques de la s\u00e9questration pulmonaire Quelles sont les caract\u00e9ristiques \u00e9chographiques typiques d\u2019une s\u00e9questration pulmonaire ?<\/em><\/strong><\/p><ol><li><br \/>Masse hyper\u00e9chog\u00e8ne bien d\u00e9limit\u00e9e<br \/>B. Pr\u00e9sence d\u2019une vascularisation syst\u00e9mique en Doppler couleur<br \/>C. Communication avec les bronches<br \/>D. Situation possible intra- ou extralobaire<br \/>E. \u00c9volution fr\u00e9quente vers une r\u00e9gression spontan\u00e9e<\/li><\/ol><p>\u2705 <strong>R\u00e9ponses exactes : A, B et D<\/strong><br \/>\u27a1 <strong>Explication :<\/strong><\/p><ul><li>La <strong>s\u00e9questration pulmonaire<\/strong> se manifeste par une <strong>masse hyper\u00e9chog\u00e8ne bien d\u00e9finie<\/strong>.<\/li><li>Une <strong>vascularisation syst\u00e9mique<\/strong> est toujours pr\u00e9sente, ce qui est confirm\u00e9 ici par le Doppler couleur montrant une <strong>art\u00e8re issue de l\u2019aorte<\/strong>.<\/li><li>Contrairement \u00e0 la MAKP, la s\u00e9questration <strong>ne communique pas avec les bronches<\/strong> (C est donc faux).<\/li><li>Elle peut \u00eatre <strong>intralobaire ou extralobaire<\/strong>, cette derni\u00e8re forme \u00e9tant plus souvent associ\u00e9e \u00e0 des malformations cong\u00e9nitales.<\/li><li>La r\u00e9gression spontan\u00e9e est rare, contrairement \u00e0 certaines MAKP qui peuvent diminuer en taille durant la grossesse.<\/li><\/ul><p><strong><em>\u00a0<\/em><\/strong><strong><em>54 : Quelle(s) complication(s) peut\/peuvent survenir en cas de s\u00e9questration pulmonaire f\u0153tale ?<\/em><\/strong><\/p><ol><li><br \/>Hydrops f\u0153tal<br \/>B. Compression m\u00e9diastinale avec d\u00e9viation cardiaque<br \/>C. Infections pulmonaires postnatales<br \/>D. Transformation maligne en postnatal<br \/>E. Obstruction bronchique<\/li><\/ol><p>\u2705 <strong>R\u00e9ponses exactes : A, B et C<\/strong><br \/>\u27a1 <strong>Explication :<\/strong><\/p><ul><li>Une <strong>s\u00e9questration pulmonaire volumineuse<\/strong> peut entra\u00eener un <strong>hydrops f\u0153tal<\/strong> en raison de la compression des structures vasculaires thoraciques.<\/li><li>Une <strong>compression m\u00e9diastinale avec d\u00e9placement du c\u0153ur<\/strong> peut survenir.<\/li><li>En postnatal, une s\u00e9questration pulmonaire <strong>peut s\u2019infecter<\/strong>, n\u00e9cessitant alors une prise en charge chirurgicale.<\/li><li>Il n\u2019y a <strong>pas de risque de transformation maligne<\/strong>.<\/li><li>La s\u00e9questration ne communique pas avec les bronches, donc elle <strong>n\u2019entra\u00eene pas d\u2019obstruction bronchique<\/strong>.<\/li><\/ul><p><strong><em>55 : Quelle(s) approche(s) th\u00e9rapeutique(s) peut\/peuvent \u00eatre envisag\u00e9e(s) en cas de s\u00e9questration pulmonaire pr\u00e9natale ?<\/em><\/strong><\/p><ol><li><br \/>Surveillance \u00e9chographique r\u00e9guli\u00e8re<br \/>B. Embolisation pr\u00e9natale des vaisseaux nourriciers<br \/>C. Drainage f\u0153tal en cas de compression s\u00e9v\u00e8re<br \/>D. R\u00e9section chirurgicale postnatale si symptomatique<br \/>E. Traitement antibiotique syst\u00e9matique en postnatal<\/li><\/ol><p>\u2705 <strong>R\u00e9ponses exactes : A, C et D<\/strong><br \/>\u27a1 <strong>Explication :<\/strong><\/p><ul><li>Une <strong>surveillance \u00e9chographique<\/strong> est essentielle pour suivre l\u2019\u00e9volution de la l\u00e9sion et d\u00e9tecter d\u2019\u00e9ventuelles complications.<\/li><li>Une <strong>embolisation pr\u00e9natale<\/strong> n\u2019est pas une approche courante in utero.<\/li><li>Un <strong>drainage f\u0153tal<\/strong> peut \u00eatre envisag\u00e9 en cas d\u2019hydrops mena\u00e7ant la survie f\u0153tale.<\/li><li>Une <strong>r\u00e9section chirurgicale postnatale<\/strong> est indiqu\u00e9e si la s\u00e9questration est symptomatique ou s\u2019infecte.<\/li><li>Un <strong>traitement antibiotique syst\u00e9matique<\/strong> n\u2019est pas n\u00e9cessaire en l\u2019absence d\u2019infection.<\/li><\/ul><p>\u00a0<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-d424c04 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"d424c04\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-9e7c249\" data-id=\"9e7c249\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-05d75e9 elementor-widget elementor-widget-text-editor\" data-id=\"05d75e9\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: justify;\">Quiz<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7f9729c elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"7f9729c\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-412fe3c elementor-widget elementor-widget-text-editor\" data-id=\"412fe3c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: center;\">\n            <div class='ays-quiz-container ays_quiz_classic_light   ays-quiz-keyboard-active' data-quest-effect='none'  data-hide-bg-image='false' id='ays-quiz-container-9'>\n                \n                \n                <div class='ays-questions-container'>\n                    \n                    \n                    \n                    <form action='' method='post' id='ays_finish_quiz_9' \n                        class='ays-quiz-form  enable_questions_result '\n                    >\n            <input type='hidden' value='list' class='answer_view_class'>\n            <input type='hidden' value='' class='ays_qm_enable_arrows'><section  class='ays_quiz_timer_container'>\n                <div class='ays-quiz-timer ays-quiz-message-before-timer' data-timer='450'><p>Ce quiz comporte 15 QCM.<br \/>\nUne ou plusieurs r\u00e9ponses sont exactes pour chaque QCM.<br \/>\nUn score minimum de 75% de r\u00e9ponses exactes est requis.<br \/>\nLe temps imparti est de 7 minutes<\/p>\n<\/div>\n                <div class='ays-quiz-after-timer '><p>Le temps imparti est \u00e9coul\u00e9<\/p>\n<\/div>\n                <hr style='height:1px;'>\n            <\/section>\n            \n            \n            <div class='step active-step'>\n                <div class='ays-abs-fs ays-start-page'>\n                    \n                    \n                    <p class='ays-fs-title'>Le Thorax F\u0153tal<\/p>\n                    <div class='ays-fs-subtitle'><\/div>\n                    <input type='hidden' name='ays_quiz_id' value='9'\/>\n                    <input type='hidden' name='ays_quiz_finish_nonce' value='8c1a676f32'>\n                    <input type='hidden' name='ays_quiz_curent_page_link' class='ays-quiz-curent-page-link' value='http:\/\/echonews.fr\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F5032'\/>\n                    <input type='hidden' name='ays_quiz_questions' value='268,243,246,263,245,261,251,250,274,280,249,227,273,257,232'>\n                    \n                    \n                    <input type='button'   class='ays_next start_button action-button ays-quiz-keyboard-active' value='D\u00e9marrer' data-enable-leave-page=\"false\" \/>\n                    \n                    <\/div>\n                <\/div><div class='step ' data-question-id='268' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>1 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong><em>Quelle(s) \u00e9volution(s) possible(s) peut\/peuvent \u00eatre observ\u00e9e(s) en cas d\u2019hydrothorax unilat\u00e9ral ?<\/em><\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-268]' id='ays-answer-1277-9' value='1277'\/>\n\n                <label for='ays-answer-1277-9' class='  ays_position_initial  ays-quiz-keyboard-label'>R\u00e9sorption spontan\u00e9e<\/label><label for='ays-answer-1277-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-268]' id='ays-answer-1278-9' value='1278'\/>\n\n                <label for='ays-answer-1278-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Progression vers un hydrothorax bilat\u00e9ral<\/label><label for='ays-answer-1278-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-268]' id='ays-answer-1281-9' value='1281'\/>\n\n                <label for='ays-answer-1281-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Obstruction compl\u00e8te des bronches<\/label><label for='ays-answer-1281-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-268]' id='ays-answer-1280-9' value='1280'\/>\n\n                <label for='ays-answer-1280-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Apparition d\u2019une ascite secondaire<\/label><label for='ays-answer-1280-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-268]' id='ays-answer-1279-9' value='1279'\/>\n\n                <label for='ays-answer-1279-9' class='  ays_position_initial  ays-quiz-keyboard-label'>D\u00e9veloppement d\u2019un hydrops f\u0153tal<\/label><label for='ays-answer-1279-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_9 === 'undefined'){\n                window.quizOptions_9 = [];\n            }\n            window.quizOptions_9['268'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                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class='ays_quiz_question'>\n                                <p><strong><em>Quelle est la prise en charge pr\u00e9natale d\u2019un chylothorax volumineux ?<\/em><\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-243]' id='ays-answer-1154-9' value='1154'\/>\n\n                <label for='ays-answer-1154-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Pose d\u2019un shunt pleuro-amniotique<\/label><label for='ays-answer-1154-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-243]' id='ays-answer-1153-9' value='1153'\/>\n\n                <label for='ays-answer-1153-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Ponction pleurale in utero<\/label><label for='ays-answer-1153-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-243]' id='ays-answer-1152-9' value='1152'\/>\n\n                <label for='ays-answer-1152-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Surveillance \u00e9chographique rapproch\u00e9e<\/label><label for='ays-answer-1152-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-243]' id='ays-answer-1156-9' value='1156'\/>\n\n                <label for='ays-answer-1156-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Transfusion intra-ut\u00e9rine syst\u00e9matique<\/label><label for='ays-answer-1156-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-243]' id='ays-answer-1155-9' value='1155'\/>\n\n    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             <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='246' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>3 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong><em>Quels sont les signes \u00e9chographiques typiques d\u2019une hernie diaphragmatique cong\u00e9nitale ?<\/em><\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-246]' id='ays-answer-1169-9' value='1169'\/>\n\n                <label for='ays-answer-1169-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Hypoplasie pulmonaire du c\u00f4t\u00e9 atteint<\/label><label for='ays-answer-1169-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-246]' id='ays-answer-1168-9' value='1168'\/>\n\n                <label for='ays-answer-1168-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Estomac et\/ou anses intestinales en position thoracique<\/label><label for='ays-answer-1168-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-246]' id='ays-answer-1170-9' value='1170'\/>\n\n                <label for='ays-answer-1170-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Visualisation du foie intra-thoracique dans certains cas<\/label><label for='ays-answer-1170-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-246]' id='ays-answer-1171-9' value='1171'\/>\n\n                <label for='ays-answer-1171-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Pr\u00e9sence d\u2019une ascite isol\u00e9e<\/label><label for='ays-answer-1171-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-246]' id='ays-answer-1167-9' value='1167'\/>\n\n                <label for='ays-answer-1167-9' class='  ays_position_initial  ays-quiz-keyboard-label'>D\u00e9placement du m\u00e9diastin vers le c\u00f4t\u00e9 oppos\u00e9<\/label><label for='ays-answer-1167-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_9 === 'undefined'){\n                window.quizOptions_9 = [];\n            }\n            window.quizOptions_9['246'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='263' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>4 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong><em>Quelle(s) pathologie(s) peut\/peuvent \u00eatre associ\u00e9e(s) \u00e0 un hydrothorax f\u0153tal ?<\/em><\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-263]' id='ays-answer-1256-9' value='1256'\/>\n\n                <label for='ays-answer-1256-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Dysplasie bronchopulmonaire<\/label><label for='ays-answer-1256-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-263]' id='ays-answer-1252-9' value='1252'\/>\n\n                <label for='ays-answer-1252-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Chylothorax cong\u00e9nital<\/label><label for='ays-answer-1252-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-263]' id='ays-answer-1255-9' value='1255'\/>\n\n                <label for='ays-answer-1255-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Hernie diaphragmatique<\/label><label for='ays-answer-1255-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-263]' id='ays-answer-1253-9' value='1253'\/>\n\n                <label for='ays-answer-1253-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Hydrops f\u0153tal<\/label><label for='ays-answer-1253-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-263]' id='ays-answer-1254-9' value='1254'\/>\n\n                <label for='ays-answer-1254-9' class='  ays_position_initial  ays-quiz-keyboard-label'>S\u00e9quence d\u2019obstruction bronchique<\/label><label for='ays-answer-1254-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_9 === 'undefined'){\n                window.quizOptions_9 = [];\n            }\n            window.quizOptions_9['263'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='245' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>5 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong><em>Quel est le diagnostic le plus probable sur cette image \u00e9chographique ?<\/em><\/strong><\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-1-article-Prenatal-diagnosis-imaging-and-prognosis-in-Congenital-Diaphragmatic-Hernia-300x280.jpg\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" ays-quiz-keyboard-active\" tabindex='0'><\/div>\n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-245]' id='ays-answer-1166-9' value='1166'\/>\n\n                <label for='ays-answer-1166-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Malformation ad\u00e9nomato\u00efde kystique du poumon (CCAM)<\/label><label for='ays-answer-1166-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-245]' id='ays-answer-1162-9' value='1162'\/>\n\n                <label for='ays-answer-1162-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Hernie diaphragmatique cong\u00e9nitale (HDC)<\/label><label for='ays-answer-1162-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-245]' id='ays-answer-1163-9' value='1163'\/>\n\n                <label for='ays-answer-1163-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Chylothorax f\u0153tal<\/label><label for='ays-answer-1163-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-245]' id='ays-answer-1164-9' value='1164'\/>\n\n                <label for='ays-answer-1164-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Atr\u00e9sie de l\u2019\u0153sophage<\/label><label for='ays-answer-1164-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-245]' id='ays-answer-1165-9' value='1165'\/>\n\n                <label for='ays-answer-1165-9' class='  ays_position_initial  ays-quiz-keyboard-label'>S\u00e9questration pulmonaire<\/label><label for='ays-answer-1165-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_9 === 'undefined'){\n                window.quizOptions_9 = [];\n            }\n            window.quizOptions_9['245'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='261' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>6 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong><em>Quelle est la prise en charge pr\u00e9natale recommand\u00e9e pour une HDC s\u00e9v\u00e8re ?<\/em><\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-261]' id='ays-answer-1242-9' value='1242'\/>\n\n                <label for='ays-answer-1242-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Surveillance \u00e9chographique rapproch\u00e9e<\/label><label for='ays-answer-1242-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-261]' id='ays-answer-1244-9' value='1244'\/>\n\n                <label for='ays-answer-1244-9' class='  ays_position_initial  ays-quiz-keyboard-label'>C\u00e9sarienne obligatoire \u00e0 la naissance<\/label><label for='ays-answer-1244-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-261]' id='ays-answer-1245-9' value='1245'\/>\n\n                <label for='ays-answer-1245-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Corticoth\u00e9rapie pour maturation pulmonaire<\/label><label for='ays-answer-1245-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-261]' id='ays-answer-1243-9' value='1243'\/>\n\n                <label for='ays-answer-1243-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Occlusion trach\u00e9ale f\u0153toscopique (FETO)<\/label><label for='ays-answer-1243-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-261]' id='ays-answer-1246-9' value='1246'\/>\n\n                <label for='ays-answer-1246-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Interruption m\u00e9dicale de grossesse syst\u00e9matique<\/label><label for='ays-answer-1246-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_9 === 'undefined'){\n                window.quizOptions_9 = [];\n            }\n            window.quizOptions_9['261'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='251' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>7 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p style=\"line-height: 115%\"><strong><i><span>Quelles structures sont mises en \u00e9vidence par les couleurs sur ces images ?<\/span><\/i><\/strong><\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-2-article-Prenatal-diagnosis-imaging-and-prognosis-in-Congenital-Diaphragmatic-Hernia-300x287.jpg\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" ays-quiz-keyboard-active\" tabindex='0'><\/div>\n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-251]' id='ays-answer-1196-9' value='1196'\/>\n\n                <label for='ays-answer-1196-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Le liquide amniotique<\/label><label for='ays-answer-1196-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-251]' id='ays-answer-1192-9' value='1192'\/>\n\n                <label for='ays-answer-1192-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Le foie en position intra-thoracique<\/label><label for='ays-answer-1192-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-251]' id='ays-answer-1195-9' value='1195'\/>\n\n                <label for='ays-answer-1195-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Le diaphragme en position normale<\/label><label for='ays-answer-1195-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-251]' id='ays-answer-1193-9' value='1193'\/>\n\n                <label for='ays-answer-1193-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Les poumons f\u0153taux<\/label><label for='ays-answer-1193-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-251]' id='ays-answer-1194-9' value='1194'\/>\n\n                <label for='ays-answer-1194-9' class='  ays_position_initial  ays-quiz-keyboard-label'>L\u2019intestin herni\u00e9<\/label><label for='ays-answer-1194-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_9 === 'undefined'){\n                window.quizOptions_9 = [];\n            }\n            window.quizOptions_9['251'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='250' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>8 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong><em>Que repr\u00e9sente cette s\u00e9rie d\u2019images en coupes axiales f\u0153tales ?<\/em><\/strong><\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-2-article-Prenatal-diagnosis-imaging-and-prognosis-in-Congenital-Diaphragmatic-Hernia-300x287.jpg\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" ays-quiz-keyboard-active\" tabindex='0'><\/div>\n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-250]' id='ays-answer-1187-9' value='1187'\/>\n\n                <label for='ays-answer-1187-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Une s\u00e9quence d\u2019imagerie de l\u2019abdomen f\u0153tal<\/label><label for='ays-answer-1187-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-250]' id='ays-answer-1191-9' value='1191'\/>\n\n                <label for='ays-answer-1191-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Une analyse Doppler des flux sanguins pulmonaires<\/label><label for='ays-answer-1191-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-250]' id='ays-answer-1189-9' value='1189'\/>\n\n                <label for='ays-answer-1189-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Une classification des degr\u00e9s de s\u00e9v\u00e9rit\u00e9 de l\u2019HDC<\/label><label for='ays-answer-1189-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-250]' id='ays-answer-1190-9' value='1190'\/>\n\n                <label for='ays-answer-1190-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Une comparaison entre une IRM f\u0153tale et une \u00e9chographie standard<\/label><label for='ays-answer-1190-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-250]' id='ays-answer-1188-9' value='1188'\/>\n\n                <label for='ays-answer-1188-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Une \u00e9volution progressive d\u2019une hernie diaphragmatique cong\u00e9nitale (HDC)<\/label><label for='ays-answer-1188-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_9 === 'undefined'){\n                window.quizOptions_9 = [];\n            }\n            window.quizOptions_9['250'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='274' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>9 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong><em>Que montre cette image \u00e9chographique ?<\/em><\/strong><\/p>\n\n                            <\/div>\n                            <div class=\"ays-image-question-img\"><img decoding=\"async\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Figure-18.12-du-Chapitre-18-Thorax-livre-Gilles-Grange-CORR-239x300.jpg\"   alt=\"\" style='width:100%;height:auto;object-fit:cover;object-position:center center;' class=\" ays-quiz-keyboard-active\" tabindex='0'><\/div>\n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-274]' id='ays-answer-1307-9' value='1307'\/>\n\n                <label for='ays-answer-1307-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Une malformation ad\u00e9nomato\u00efde kystique pulmonaire (MAKP) microkystique<\/label><label for='ays-answer-1307-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-274]' id='ays-answer-1311-9' value='1311'\/>\n\n                <label for='ays-answer-1311-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Une hernie diaphragmatique<\/label><label for='ays-answer-1311-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-274]' id='ays-answer-1310-9' value='1310'\/>\n\n                <label for='ays-answer-1310-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Un hydrops f\u0153tal<\/label><label for='ays-answer-1310-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-274]' id='ays-answer-1308-9' value='1308'\/>\n\n                <label for='ays-answer-1308-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Un \u00e9panchement pleural an\u00e9chog\u00e8ne<\/label><label for='ays-answer-1308-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-274]' id='ays-answer-1309-9' value='1309'\/>\n\n                <label for='ays-answer-1309-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Une s\u00e9questration pulmonaire<\/label><label for='ays-answer-1309-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_9 === 'undefined'){\n                window.quizOptions_9 = [];\n            }\n            window.quizOptions_9['274'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='280' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>10 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong><em>Quelle(s) complication(s) peut\/peuvent survenir en cas de s\u00e9questration pulmonaire f\u0153tale ?<\/em><\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-280]' id='ays-answer-1340-9' value='1340'\/>\n\n                <label for='ays-answer-1340-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Transformation maligne en postnatal<\/label><label for='ays-answer-1340-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-280]' id='ays-answer-1341-9' value='1341'\/>\n\n                <label for='ays-answer-1341-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Obstruction bronchique<\/label><label for='ays-answer-1341-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-280]' id='ays-answer-1339-9' value='1339'\/>\n\n                <label for='ays-answer-1339-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Infections pulmonaires postnatales<\/label><label for='ays-answer-1339-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-280]' id='ays-answer-1337-9' value='1337'\/>\n\n                <label for='ays-answer-1337-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Hydrops f\u0153tal<\/label><label for='ays-answer-1337-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-280]' id='ays-answer-1338-9' value='1338'\/>\n\n                <label for='ays-answer-1338-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Compression m\u00e9diastinale avec d\u00e9viation cardiaque<\/label><label for='ays-answer-1338-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_9 === 'undefined'){\n                window.quizOptions_9 = [];\n            }\n            window.quizOptions_9['280'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='249' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>11 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong><em>Quelle est la prise en charge pr\u00e9natale possible d\u2019une HDC s\u00e9v\u00e8re ?<\/em><\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-249]' id='ays-answer-1184-9' value='1184'\/>\n\n                <label for='ays-answer-1184-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Occlusion trach\u00e9ale f\u0153toscopique (FETO)<\/label><label for='ays-answer-1184-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-249]' id='ays-answer-1183-9' value='1183'\/>\n\n                <label for='ays-answer-1183-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Pose d\u2019un shunt pleuro-amniotique<\/label><label for='ays-answer-1183-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-249]' id='ays-answer-1182-9' value='1182'\/>\n\n                <label for='ays-answer-1182-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Surveillance \u00e9chographique rapproch\u00e9e<\/label><label for='ays-answer-1182-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-249]' id='ays-answer-1186-9' value='1186'\/>\n\n                <label for='ays-answer-1186-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Corticoth\u00e9rapie pr\u00e9natale pour la maturation pulmonaire<\/label><label for='ays-answer-1186-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-249]' id='ays-answer-1185-9' value='1185'\/>\n\n                <label for='ays-answer-1185-9' class='  ays_position_initial  ays-quiz-keyboard-label'>C\u00e9sarienne obligatoire \u00e0 la naissance<\/label><label for='ays-answer-1185-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_9 === 'undefined'){\n                window.quizOptions_9 = [];\n            }\n            window.quizOptions_9['249'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='227' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>12 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong>Quels sont les signes \u00e9chographiques \u00e9vocateurs d\u2019une hernie diaphragmatique cong\u00e9nitale ?<\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-227]' id='ays-answer-1074-9' value='1074'\/>\n\n                <label for='ays-answer-1074-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Absence de visualisation du diaphragme<\/label><label for='ays-answer-1074-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-227]' id='ays-answer-1075-9' value='1075'\/>\n\n                <label for='ays-answer-1075-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Hydramnios<\/label><label for='ays-answer-1075-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-227]' id='ays-answer-1073-9' value='1073'\/>\n\n                <label for='ays-answer-1073-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Pr\u00e9sence d\u2019organes abdominaux dans le thorax<\/label><label for='ays-answer-1073-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-227]' id='ays-answer-1076-9' value='1076'\/>\n\n                <label for='ays-answer-1076-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Poumons hyper\u00e9chog\u00e8nes<\/label><label for='ays-answer-1076-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-227]' id='ays-answer-1072-9' value='1072'\/>\n\n                <label for='ays-answer-1072-9' class='  ays_position_initial  ays-quiz-keyboard-label'>D\u00e9placement du c\u0153ur<\/label><label for='ays-answer-1072-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_9 === 'undefined'){\n                window.quizOptions_9 = [];\n            }\n            window.quizOptions_9['227'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='273' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>13 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong><em>Quelle(s) approche(s) th\u00e9rapeutique(s) peut\/peuvent \u00eatre envisag\u00e9e(s) dans la prise en charge d\u2019une MAKP volumineuse avec retentissement f\u0153tal ?<\/em><\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-273]' id='ays-answer-1304-9' value='1304'\/>\n\n                <label for='ays-answer-1304-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Administration maternelle de cortico\u00efdes en cas de risque d\u2019accouchement pr\u00e9matur\u00e9<\/label><label for='ays-answer-1304-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-273]' id='ays-answer-1306-9' value='1306'\/>\n\n                <label for='ays-answer-1306-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Embolisation des vaisseaux irriguant la masse<\/label><label for='ays-answer-1306-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-273]' id='ays-answer-1303-9' value='1303'\/>\n\n                <label for='ays-answer-1303-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Ponction ou drainage in utero des kystes volumineux<\/label><label for='ays-answer-1303-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-273]' id='ays-answer-1302-9' value='1302'\/>\n\n                <label for='ays-answer-1302-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Surveillance \u00e9chographique rapproch\u00e9e<\/label><label for='ays-answer-1302-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-273]' id='ays-answer-1305-9' value='1305'\/>\n\n                <label for='ays-answer-1305-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Ex\u00e9r\u00e8se chirurgicale postnatale en cas de persistance symptomatique<\/label><label for='ays-answer-1305-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_9 === 'undefined'){\n                window.quizOptions_9 = [];\n            }\n            window.quizOptions_9['273'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='257' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>14 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong><em>Quel est l\u2019apport de l\u2019\u00e9chographie 3D dans l\u2019\u00e9valuation du syndrome de Pallister-Killian ?<\/em><\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-257]' id='ays-answer-1225-9' value='1225'\/>\n\n                <label for='ays-answer-1225-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Am\u00e9liore le conseil pr\u00e9natal pour les parents<\/label><label for='ays-answer-1225-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-257]' id='ays-answer-1224-9' value='1224'\/>\n\n                <label for='ays-answer-1224-9' class='  ays_position_initial  ays-quiz-keyboard-label'>D\u00e9tecte les anomalies g\u00e9n\u00e9tiques<\/label><label for='ays-answer-1224-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-257]' id='ays-answer-1223-9' value='1223'\/>\n\n                <label for='ays-answer-1223-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Remplace totalement l\u2019IRM c\u00e9r\u00e9brale<\/label><label for='ays-answer-1223-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-257]' id='ays-answer-1222-9' value='1222'\/>\n\n                <label for='ays-answer-1222-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Permet une meilleure visualisation des anomalies faciales<\/label><label for='ays-answer-1222-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-257]' id='ays-answer-1226-9' value='1226'\/>\n\n                <label for='ays-answer-1226-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Permet une meilleure \u00e9valuation du volume pulmonaire<\/label><label for='ays-answer-1226-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_9 === 'undefined'){\n                window.quizOptions_9 = [];\n            }\n            window.quizOptions_9['257'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_previous action-button ays-quiz-keyboard-active ' value='Pr\u00e9c\u00e9dent' \/>\n                        \n                        <i class=\"ays_fa ays_fa_arrow_right ays_next action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                        <input type='button' class='ays_next action-button ays-quiz-keyboard-active ' value='Suivant' \/>\n                    <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ' data-question-id='232' data-type='checkbox'>\n                    \n                    \n                    <p class='ays-question-counter animated'>15 \/ 15<\/p>\n                    <div class='ays-abs-fs'>\n                        \n                        <div class='ays_quiz_question'>\n                                <p><strong><em>Quelles anomalies peuvent \u00eatre associ\u00e9es \u00e0 une hernie diaphragmatique cong\u00e9nitale ?<\/em><\/strong><\/p>\n\n                            <\/div>\n                            \n                        <div class='ays-quiz-answers ays_list_view_container  '>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-232]' id='ays-answer-1097-9' value='1097'\/>\n\n                <label for='ays-answer-1097-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Malformations cardiaques<\/label><label for='ays-answer-1097-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-232]' id='ays-answer-1100-9' value='1100'\/>\n\n                <label for='ays-answer-1100-9' class='  ays_position_initial  ays-quiz-keyboard-label'>S\u00e9questration pulmonaire<\/label><label for='ays-answer-1100-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-232]' id='ays-answer-1098-9' value='1098'\/>\n\n                <label for='ays-answer-1098-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Anomalies chromosomiques<\/label><label for='ays-answer-1098-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-232]' id='ays-answer-1099-9' value='1099'\/>\n\n                <label for='ays-answer-1099-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Hypoplasie pulmonaire<\/label><label for='ays-answer-1099-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div>\n            <div class='ays-field ays_list_view_item ays-quiz-keyboard-active' tabindex='0' >\n                <input type='hidden' name='ays_answer_correct[]' value='0'\/>\n\n                <input type='checkbox' name='ays_questions[ays-question-232]' id='ays-answer-1101-9' value='1101'\/>\n\n                <label for='ays-answer-1101-9' class='  ays_position_initial  ays-quiz-keyboard-label'>Anomalies digestives<\/label><label for='ays-answer-1101-9' class='ays_answer_image ays_answer_image_class ays_empty_before_content'><\/label>\n\n            <\/div><script>\n            if(typeof window.quizOptions_9 === 'undefined'){\n                window.quizOptions_9 = [];\n            }\n            window.quizOptions_9['232'] = 'W10=';<\/script><\/div>                        \n                        \n                        \n                        <div class='ays_buttons_div'>\n                            \n                            <i class=\"ays_fa ays_fa_arrow_left ays_previous action-button ays_arrow ays-quiz-keyboard-active ays_display_none\" tabindex='0'><\/i>\n                            <input type='button' class='ays_previous action-button ays-quiz-keyboard-active '  value='Pr\u00e9c\u00e9dent' \/>\n                            <i class='ays_display_none ays_fa ays_fa_flag_checkered ays_finish action-button ays_arrow ays_next_arrow ays-quiz-keyboard-active' tabindex='0'><\/i><input type='submit' name='ays_finish_quiz' class='  ays_next ays_finish action-button ays-quiz-keyboard-active' value='Voir le r\u00e9sultat'\/>\n                        <\/div>\n                        \n                        <div class='wrong_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='right_answer_text ays_do_not_show' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays_questtion_explanation' style='display:none'>\n                            \n                        <\/div>\n                        <div class='ays-quiz-additonal-box'>\n                            \n                        <\/div>   \n                        \n                        \n                    <\/div>\n                <\/div><div class='step ays_thank_you_fs'>\n            <div class='ays-abs-fs ays-end-page'><div data-class='lds-ellipsis' data-role='loader' class='ays-loader'><div><\/div><div><\/div><div><\/div><div><\/div><\/div><div class='ays_quiz_results_page'><div class='ays_score_message'><\/div><div class='ays_message'><\/div><p class='ays_score ays_score_display_none animated'>Your score is<\/p><p class='ays_average'>The average score is 36%<\/p><div class='ays-progress third'>\n                <span class='ays-progress-value third'>0%<\/span>\n                <div class='ays-progress-bg third'>\n                    <div class='ays-progress-bar third' style='width:0%;'><\/div>\n                <\/div>\n            <\/div><p class='ays_restart_button_p'><button type='button' class='action-button ays_restart_button ays-quiz-keyboard-active'>\n                    <i class='ays_fa ays_fa_undo'><\/i>\n                    <span>Relancer le quiz<\/span>\n                <\/button><\/p><\/div>\n            <\/div>\n        <\/div><style>\n            div#ays-quiz-container-9 * {\n                box-sizing: border-box;\n            }\n\n            #ays-quiz-container-9 [id^='ays_finish_quiz_'] div.step div.ays-abs-fs {\n                width: 90%;\n            }\n\n            \/* Styles for Internet Explorer start *\/\n            #ays-quiz-container-9 #ays_finish_quiz_9 {\n                \n            }\n\n            \/* Styles for Quiz container *\/\n            #ays-quiz-container-9{\n                min-height: 400px;\n                width:800px;\n                background-color:#fff;\n                background-position:center center;border-radius:8px;box-shadow: none;border-width: 1px;border-style: solid;border-color: #000;}\n\n            \/* Styles for questions *\/\n            #ays-quiz-container-9 #ays_finish_quiz_9 div.step {\n                min-height: 400px;\n            }\n\n            \/* Styles for text inside quiz container 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         text-decoration: none;\n                letter-spacing: 0px;\n                font-weight: normal;\n            }\n\n            #ays-quiz-container-9 .right_answer_text p {\n                font-size:15px;\n            }\n\n            #ays-quiz-container-9 .ays-quiz-question-note-message-box p {\n                font-size:14px;\n            }\n\n            #ays-quiz-container-9 .ays-quiz-question-note-message-box *:not(strong) {\n                text-transform:none;\n                text-decoration: none;\n                letter-spacing: 0px;\n                font-weight: normal;\n            }\n            \n            #ays-quiz-container-9 .ays_cb_and_a,\n            #ays-quiz-container-9 .ays_cb_and_a * {\n                color: rgb(0,0,0);\n                text-align: center;\n            }\n\n            \/* Quiz textarea height *\/\n            #ays-quiz-container-9 textarea {\n                height: 100px;\n                min-height: 100px;\n            }\n\n            \/* Quiz rate and passed users count *\/\n            #ays-quiz-container-9 .ays_quizn_ancnoxneri_qanak,\n            #ays-quiz-container-9 .ays_quiz_rete_avg {\n                color:#fff !important;\n                background-color:#000000;   \n            }\n\n            #ays-quiz-container-9 .ays-questions-container > .ays_quizn_ancnoxneri_qanak {\n                padding: 5px 20px;\n            }\n            #ays-quiz-container-9 div.for_quiz_rate.ui.star.rating .icon {\n                color: rgba(0,0,0,0.35);\n            }\n            #ays-quiz-container-9 .ays_quiz_rete_avg div.for_quiz_rate_avg.ui.star.rating .icon {\n                color: rgba(255,255,255,0.5);\n            }\n\n            #ays-quiz-container-9 .ays_quiz_rete .ays-quiz-rate-link-box .ays-quiz-rate-link {\n                color: #000000;\n            }\n\n            \/* Loaders *\/            \n            #ays-quiz-container-9 div.lds-spinner,\n            #ays-quiz-container-9 div.lds-spinner2 {\n                color: #000000;\n            }\n            #ays-quiz-container-9 div.lds-spinner div:after,\n            #ays-quiz-container-9 div.lds-spinner2 div:after {\n                background-color: #000000;\n            }\n            #ays-quiz-container-9 .lds-circle,\n            #ays-quiz-container-9 .lds-facebook div,\n            #ays-quiz-container-9 .lds-ellipsis div{\n                background: #000000;\n            }\n            #ays-quiz-container-9 .lds-ripple div{\n                border-color: #000000;\n            }\n            #ays-quiz-container-9 .lds-dual-ring::after,\n            #ays-quiz-container-9 .lds-hourglass::after{\n                border-color: #000000 transparent #000000 transparent;\n            }\n\n            \/* Stars *\/\n            #ays-quiz-container-9 .ui.rating .icon,\n            #ays-quiz-container-9 .ui.rating .icon:before {\n                font-family: Rating !important;\n            }\n\n            \/* Progress bars *\/\n            #ays-quiz-container-9 #ays_finish_quiz_9 .ays-progress {\n                border-color: rgba(0,0,0,0.8);\n            }\n            #ays-quiz-container-9 #ays_finish_quiz_9 .ays-progress-bg {\n                background-color: rgba(0,0,0,0.3);\n            }    \n            #ays-quiz-container-9 .ays-progress-value {\n                color: #000000;\n                text-align: center;\n            }\n            #ays-quiz-container-9 .ays-progress-bar {\n                background-color: #449aba;\n            }\n            #ays-quiz-container-9 .ays-question-counter .ays-live-bar-wrap {\n                direction:ltr !important;\n            }\n            #ays-quiz-container-9 .ays-live-bar-fill{\n                color: #000000;\n                border-bottom: 2px solid rgba(0,0,0,0.8);\n                text-shadow: 0px 0px 5px #fff;\n            }\n            #ays-quiz-container-9 .ays-live-bar-fill.ays-live-fourth,\n            #ays-quiz-container-9 .ays-live-bar-fill.ays-live-third,\n            #ays-quiz-container-9 .ays-live-bar-fill.ays-live-second {\n                text-shadow: unset;\n            }\n            #ays-quiz-container-9 .ays-live-bar-percent{\n                display:none;\n            }\n            #ays-quiz-container-9 #ays_finish_quiz_9 .ays_average {\n                text-align: center;\n            }\n            \n            \/* Music, Sound *\/\n            #ays-quiz-container-9 .ays_music_sound {\n                color:rgb(0,0,0);\n            }\n\n            \/* Dropdown questions scroll bar *\/\n            #ays-quiz-container-9 blockquote {\n                border-left-color: #000000 !important;                                      \n            }\n\n            \/* Quiz Password *\/\n            #ays-quiz-container-9 .ays-start-page > input[id^='ays_quiz_password_val_'],\n            #ays-quiz-container-9 .ays-quiz-password-toggle-visibility-box {\n                width: 100%;\n            }\n\n\n            \/* Question hint *\/\n            #ays-quiz-container-9 .ays_question_hint_container .ays_question_hint_text {\n                background-color:#fff;\n                box-shadow: 0 0 15px 3px rgba(201,201,201,0.6);\n                max-width: 270px;\n            }\n\n            #ays-quiz-container-9 .ays_question_hint_container .ays_question_hint_text p {\n                max-width: unset;\n            }\n\n            #ays-quiz-container-9 .ays-quiz-additonal-box {\n                display: flex;\n                justify-content: flex-end;\n                align-items: center;\n                position: relative;  \n            }\n\n            #ays-quiz-container-9 .ays_questions_hint_max_width_class {\n                max-width: 80%;\n            }\n\n            \/* Information form *\/\n            #ays-quiz-container-9 .ays-form-title{\n                color:rgb(0,0,0);\n            }\n\n            \/* Quiz timer *\/\n            #ays-quiz-container-9 div.ays-quiz-redirection-timer,\n            #ays-quiz-container-9 div.ays-quiz-timer{\n                color: #000000;\n                text-align: center;\n            }\n\n            #ays-quiz-container-9 div.ays-quiz-timer.ays-quiz-message-before-timer:before {\n                font-weight: 500;\n            }\n\n            \/* Quiz title \/ transformation *\/\n            #ays-quiz-container-9 .ays-fs-title{\n                text-transform: uppercase;\n                font-size: 23px;\n                text-align: center;\n                    text-shadow: none;\n            }\n            \n            \/* Quiz buttons *\/\n            #ays-quiz-container-9 .ays_arrow {\n                color:#ffffff!important;\n            }\n            #ays-quiz-container-9 input#ays-submit,\n            #ays-quiz-container-9 #ays_finish_quiz_9 .action-button,\n            div#ays-quiz-container-9 #ays_finish_quiz_9 .action-button.ays_restart_button,\n            #ays-quiz-container-9 + .ays-quiz-category-selective-main-container .ays-quiz-category-selective-restart-bttn,\n            #ays-quiz-container-9 .ays-quiz-category-selective-submit-bttn {\n                background: none;\n                background-color: #449aba;\n                color:#ffffff;\n                font-size: 15px;\n                padding: 10px 20px;\n                border-radius: 8px;\n                height: auto;\n                letter-spacing: 0;\n                box-shadow: unset;\n                width: auto;\n                \/* border: unset; *\/\n                min-height: unset;\n                line-height: normal;\n                text-shadow: unset;\n            }\n            #ays-quiz-container-9 input#ays-submit,\n            #ays-quiz-container-9 #ays_finish_quiz_9 input.action-button,\n            #ays-quiz-container-9 + .ays-quiz-category-selective-main-container .ays-quiz-category-selective-restart-bttn,\n            #ays-quiz-container-9 .ays-quiz-category-selective-submit-bttn {\n                \n            }\n\n            #ays-quiz-container-9 #ays_finish_quiz_9 .action-button.ays_check_answer {\n                padding: 5px 10px;\n                font-size: 15px !important;\n            }\n            #ays-quiz-container-9 #ays_finish_quiz_9 .action-button.ays_restart_button {\n                white-space: nowrap;\n                padding: 5px 10px;\n                white-space: normal;\n            }\n            #ays-quiz-container-9 input#ays-submit:hover,\n            #ays-quiz-container-9 input#ays-submit:focus,\n            #ays-quiz-container-9 #ays_finish_quiz_9 .action-button:hover,\n            #ays-quiz-container-9 #ays_finish_quiz_9 .action-button:focus,\n            #ays-quiz-container-9 + .ays-quiz-category-selective-main-container .ays-quiz-category-selective-restart-bttn:hover,\n            #ays-quiz-container-9 .ays-quiz-category-selective-submit-bttn:hover {\n                background: none;\n                box-shadow: 0 0 0 2px #ffffff;\n                background-color: #449aba;\n            }\n            #ays-quiz-container-9 .ays_restart_button {\n                color: #ffffff;\n            }\n            \n            #ays-quiz-container-9 .ays_restart_button_p,\n            #ays-quiz-container-9 .ays_buttons_div {\n                justify-content: center;\n            }\n\n            #ays-quiz-container-9 .ays_finish.action-button{\n                margin: 10px 5px;\n            }\n\n            #ays-quiz-container-9 .ays-share-btn.ays-share-btn-branded {\n                color: #fff;\n                display: inline-block;\n            }\n\n            #ays-quiz-container-9 .ays_quiz_results .ays-field.checked_answer_div.correct_div input:checked+label {\n                background-color: transparent;\n            }\n                        \n            \/* Question answers *\/\n            #ays-quiz-container-9 .ays-field {\n                    border-color: #dddddd;\n                    border-style: solid;\n                    border-width: 1px;\n                    box-shadow: none;flex-direction: row-reverse;\n            }\n            \n\n            \/* Answer maximum length of a text field *\/\n            #ays-quiz-container-9 .ays_quiz_question_text_message{\n                color: #000000;\n                text-align: left;\n                font-size: 12px;\n            }\n\n            div#ays-quiz-container-9 div.ays_quiz_question_text_error_message {\n                color: #ff0000;\n            }\n\n            \/* Questions answer image *\/\n            #ays-quiz-container-9 .ays-answer-image {\n                width:15em;\n                height:150px;\n                object-fit: cover;\n            }\n            \n            #ays-quiz-container-9 .ays-quiz-answers .ays-field:hover{\n                opacity: 1;\n            }\n            #ays-quiz-container-9 #ays_finish_quiz_9 .ays-field label.ays_answer_caption[for^='ays-answer-'] {\n                z-index: 1;\n                position:initial;bottom:0;}\n            #ays-quiz-container-9 #ays_finish_quiz_9 .ays-field input~label[for^='ays-answer-'] {\n                padding: 5px;\n            }\n\n            #ays-quiz-container-9 #ays_finish_quiz_9 .ays-field {\n                margin-bottom: 12px;\n            }\n            #ays-quiz-container-9 #ays_finish_quiz_9 .ays-field.ays_grid_view_item {\n                width: calc(50% - 6px);\n            }\n            #ays-quiz-container-9 #ays_finish_quiz_9 .ays-field.ays_grid_view_item:nth-child(odd) {\n                margin-right: 6px;\n            }\n            \n            #ays-quiz-container-9 #ays_finish_quiz_9 .ays-field input:checked+label:before {\n                border-color: #449aba;\n                background: #449aba;\n                background-clip: content-box;\n            }\n            #ays-quiz-container-9 .ays-quiz-answers div.ays-text-right-answer {\n                color: #000000;\n            }\n                        \n            \/* Questions answer right\/wrong icons *\/\n            #ays-quiz-container-9 .ays-field input~label.answered.correct:after{\n                content: url('http:\/\/echonews.fr\/wp-content\/plugins\/quiz-maker\/public\/images\/correct.png');          }\n            #ays-quiz-container-9 .ays-field input~label.answered.wrong:after{\n                content: url('http:\/\/echonews.fr\/wp-content\/plugins\/quiz-maker\/public\/images\/wrong.png');\n            }\n            #ays-quiz-container-9 .ays-field label.answered:last-of-type:after{\n                display: none;\n                height: auto;\n                left: 10px;top: 10px;}\n            \/* Dropdown questions *\/            \n            #ays-quiz-container-9 #ays_finish_quiz_9 .ays-field .select2-container--default .select2-selection--single {\n                border-bottom: 2px solid #449aba;\n                background-color: #449aba;\n            }\n            \n            #ays-quiz-container-9 .ays-field .select2-container--default .select2-selection--single .select2-selection__placeholder,\n            #ays-quiz-container-9 .ays-field .select2-container--default .select2-selection--single .select2-selection__rendered,\n            #ays-quiz-container-9 .ays-field .select2-container--default .select2-selection--single .select2-selection__arrow {\n                color: #ffffff;\n            }\n\n            #ays-quiz-container-9 .select2-container--default .select2-search--dropdown .select2-search__field:focus,\n            #ays-quiz-container-9 .select2-container--default .select2-search--dropdown .select2-search__field {\n                outline: unset;\n                padding: 0.75rem;\n            }\n\n            #ays-quiz-container-9 .ays-field .select2-container--default .select2-selection--single .select2-selection__rendered,\n            #ays-quiz-container-9 .select2-container--default .select2-results__option--highlighted[aria-selected] {\n                background-color: #449aba;\n            }\n\n            #ays-quiz-container-9 .ays-field .select2-container--default,\n            #ays-quiz-container-9 .ays-field .select2-container--default .selection,\n            #ays-quiz-container-9 .ays-field .select2-container--default .dropdown-wrapper,\n            #ays-quiz-container-9 .ays-field .select2-container--default .select2-selection--single .select2-selection__rendered,\n            #ays-quiz-container-9 .ays-field .select2-container--default .select2-selection--single .select2-selection__rendered .select2-selection__placeholder,\n            #ays-quiz-container-9 .ays-field .select2-container--default .select2-selection--single .select2-selection__arrow,\n            #ays-quiz-container-9 .ays-field .select2-container--default .select2-selection--single .select2-selection__arrow b[role='presentation'] {\n                font-size: 16px !important;\n            }\n\n            #ays-quiz-container-9 .select2-container--default .select2-results__option {\n                padding: 6px;\n            }\n            \n            \/* Dropdown questions scroll bar *\/\n            #ays-quiz-container-9 .select2-results__options::-webkit-scrollbar {\n                width: 7px;\n            }\n            #ays-quiz-container-9 .select2-results__options::-webkit-scrollbar-track {\n                background-color: rgba(255,255,255,0.35);\n            }\n            #ays-quiz-container-9 .select2-results__options::-webkit-scrollbar-thumb {\n                transition: .3s ease-in-out;\n                background-color: rgba(0,0,0,0.55);\n            }\n            #ays-quiz-container-9 .select2-results__options::-webkit-scrollbar-thumb:hover {\n                transition: .3s ease-in-out;\n                background-color: rgba(0,0,0,0.85);\n            }\n\n            \/* Audio \/ Video *\/\n            #ays-quiz-container-9 .mejs-container .mejs-time{\n                box-sizing: unset;\n            }\n            #ays-quiz-container-9 .mejs-container .mejs-time-rail {\n                padding-top: 15px;\n            }\n\n            #ays-quiz-container-9 .mejs-container .mejs-mediaelement video {\n                margin: 0;\n            }\n\n            \/* Limitation *\/\n            #ays-quiz-container-9 .ays-quiz-limitation-count-of-takers {\n                padding: 50px;\n            }\n\n            #ays-quiz-container-9 div.ays-quiz-results-toggle-block span.ays-show-res-toggle.ays-res-toggle-show,\n            #ays-quiz-container-9 div.ays-quiz-results-toggle-block span.ays-show-res-toggle.ays-res-toggle-hide{\n                color: #000000;\n            }\n\n            #ays-quiz-container-9 div.ays-quiz-results-toggle-block input:checked + label.ays_switch_toggle {\n                border: 1px solid #000000;\n            }\n\n            #ays-quiz-container-9 div.ays-quiz-results-toggle-block input:checked + label.ays_switch_toggle {\n                border: 1px solid #000000;\n            }\n\n            #ays-quiz-container-9 div.ays-quiz-results-toggle-block input:checked + label.ays_switch_toggle:after{\n                background: #000000;\n            }\n\n            #ays-quiz-container-9.ays_quiz_elegant_dark div.ays-quiz-results-toggle-block input:checked + label.ays_switch_toggle:after,\n            #ays-quiz-container-9.ays_quiz_rect_dark div.ays-quiz-results-toggle-block input:checked + label.ays_switch_toggle:after{\n                background: #000;\n            }\n\n            \/* Hestia theme (Version: 3.0.16) | Start *\/\n            #ays-quiz-container-9 .mejs-container .mejs-inner .mejs-controls .mejs-button > button:hover,\n            #ays-quiz-container-9 .mejs-container .mejs-inner .mejs-controls .mejs-button > button {\n                box-shadow: unset;\n                background-color: transparent;\n            }\n            #ays-quiz-container-9 .mejs-container .mejs-inner .mejs-controls .mejs-button > button {\n                margin: 10px 6px;\n            }\n            \/* Hestia theme (Version: 3.0.16) | End *\/\n\n            \/* Go theme (Version: 1.4.3) | Start *\/\n            #ays-quiz-container-9 label[for^='ays-answer']:before,\n            #ays-quiz-container-9 label[for^='ays-answer']:before {\n                -webkit-mask-image: unset;\n                mask-image: unset;\n            }\n\n            #ays-quiz-container-9.ays_quiz_classic_light .ays-field input:checked+label.answered.correct:before,\n            #ays-quiz-container-9.ays_quiz_classic_dark .ays-field input:checked+label.answered.correct:before {\n                background-color: #449aba !important;\n                background-color: rgba(39,174,96, 1) !important;\n            }\n            \/* Go theme (Version: 1.4.3) | End *\/\n\n            #ays-quiz-container-9 .ays_quiz_results fieldset.ays_fieldset .ays_quiz_question .wp-video {\n                width: 100% !important;\n                max-width: 100%;\n            }\n\n            \/* Classic Dark \/ Classic Light *\/\n            \/* Dropdown questions right\/wrong styles *\/\n            #ays-quiz-container-9.ays_quiz_classic_dark .correct_div,\n            #ays-quiz-container-9.ays_quiz_classic_light .correct_div{\n                border-color:green !important;\n                opacity: 1 !important;\n                background-color: rgba(39,174,96,0.4) !important;\n            }\n            #ays-quiz-container-9.ays_quiz_classic_dark .correct_div .selected-field,\n            #ays-quiz-container-9.ays_quiz_classic_light .correct_div .selected-field {\n                padding: 0px 10px 0px 10px;\n                color: green !important;\n            }\n\n            #ays-quiz-container-9.ays_quiz_classic_dark .wrong_div,\n            #ays-quiz-container-9.ays_quiz_classic_light .wrong_div{\n                border-color:red !important;\n                opacity: 1 !important;\n                background-color: rgba(243,134,129,0.4) !important;\n            }\n            #ays-quiz-container-9.ays_quiz_classic_dark .ays-field.checked_answer_div.wrong_div input:checked~label,\n            #ays-quiz-container-9.ays_quiz_classic_light .ays-field.checked_answer_div.wrong_div input:checked~label {\n                background-color: rgba(243,134,129,0.4) !important;\n            }\n            #ays-quiz-container-9.ays_quiz_classic_dark .ays-field,\n            #ays-quiz-container-9.ays_quiz_classic_light .ays-field {\n                text-align: left;\n                \/*margin-bottom: 10px;*\/\n                padding: 0;\n                transition: .3s ease-in-out;\n            }\n\n            #ays-quiz-container-9 .ays-quiz-close-full-screen {\n                fill: #000000;\n            }\n\n            #ays-quiz-container-9 .ays-quiz-open-full-screen {\n                fill: #000000;\n            }\n\n            #ays-quiz-container-9 .ays_quiz_login_form p{\n                color: #000000;\n            }\n\n            \/* report questions modal start *\/\n            .ays-modal-reports {\n                display: none;\n                position: fixed;\n                z-index: 9999;\n                left: 0;\n                top: 0;\n                width: 100%;\n                height: 100%;\n                overflow: auto;\n                background-color: rgba(0, 0, 0, 0.4);\n                animation-duration: .5s;\n                background-color: rgba(0, 0, 0, 0.4);\n            }\n\n            #ays-quiz-question-report-modal-9 .ays-modal-content-reports {\n                background-color: #fefefe;\n                margin: 10% auto;\n                border: 1px solid #888;\n                max-width: 500px;\n                width: 100%;\n                border-radius: 10px;\n                padding: 20px;\n                box-sizing: border-box;\n                position: relative;\n            }\n\n            #ays-quiz-question-report-modal-9 .ays-modal-content-reports label{\n                display: block;\n                margin-bottom: 10px;\n                font-weight: bold;\n                letter-spacing: normal;\n            }\n\n            #ays-quiz-question-report-modal-9 .ays-modal-content-reports textarea {\n                display: block;\n                width: 100%;\n                height: 100px;\n                padding: 5px;\n                box-sizing: border-box;\n                border-radius: 5px;\n                border: 1px solid #ccc;\n                max-width: 100%;\n                max-height: 500px;\n                resize: vertical;\n                transition: unset;\n            }\n\n            #ays-quiz-question-report-modal-9 .ays-modal-content-reports input.ays-quiz-submit-question-report {\n                background-color: #0073aa;\n                color: #fff !important;\n                border: none;\n                border-radius: 5px;\n                padding: 10px 20px;\n                cursor: pointer;\n                margin-top: 20px;\n                line-height: normal;\n                letter-spacing: normal;\n                box-shadow: unset;\n                background-image: unset;\n            }\n\n            #ays-quiz-question-report-modal-9 .ays-close-reports-window {\n                color: #aaa;\n                font-weight: bold;\n                position: absolute;\n                top: 1%;\n                right: 1%;\n            }\n\n            #ays-quiz-question-report-modal-9 .ays-close-reports-window img {\n                box-shadow: unset;\n            }\n            \n            #ays-quiz-question-report-modal-9 .ays-quiz-preloader img {\n                box-shadow: unset;\n            }\n\n            #ays-quiz-question-report-modal-9 .ays-close-reports-window img:hover,\n            #ays-quiz-question-report-modal-9 .ays-close-reports-window img:focus {\n                cursor: pointer;\n            }\n\n            #ays-quiz-question-report-modal-9 .ays-quiz-question-report-error {\n                display: none;\n                font-size: 13px;\n                color: #f00;\n                text-align: left;\n            }\n\n            #ays-quiz-question-report-modal-9 .ays-quiz-question-report-textarea-label,\n            #ays-quiz-question-report-modal-9 .ays-quiz-question-report-title {\n                text-align: left;\n            }\n\n            #ays-quiz-question-report-modal-9 .ays_quiz_modal_overlay {\n                width: 100%;\n                height: 100%;\n                position: fixed;\n                top: 0;\n                left: 0;\n                position: absolute;\n                z-index: 1000000000;\n                flex-direction: column;\n            }\n\n            #ays-quiz-question-report-modal-9 .ays-quiz-container .ays-quiz-user-c\u0570oosing-anonymous-assessment {\n                margin: 10px 0;\n            }\n\n            \/* report questions modal end *\/\n\n            @media screen and (max-width: 768px){\n                #ays-quiz-container-9{\n                    max-width: 100%;\n                }\n\n                div#ays-quiz-container-9 [id^='ays_finish_quiz_'] div.step div.ays-abs-fs {\n                    width: 90%;\n                }\n\n                #ays-quiz-container-9 .ays_quiz_question p {\n                    font-size: 16px;\n                }\n\n                #ays-quiz-container-9 .select2-container,\n                #ays-quiz-container-9 .ays-field * {\n                    font-size: 13px !important;\n                }\n\n                div#ays-quiz-container-9 input#ays-submit,\n                div#ays-quiz-container-9 #ays_finish_quiz_9 .action-button,\n                div#ays-quiz-container-9 #ays_finish_quiz_9 .action-button.ays_restart_button,\n                #ays-quiz-container-9 + .ays-quiz-category-selective-main-container 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#ays-quiz-container-9 .ays-quiz-question-note-message-box p {\n                    font-size:14px;\n                }\n\n                div#ays-quiz-container-9 .ays-quiz-question-note-message-box *:not(strong) {\n                    text-transform:none;\n                    text-decoration: none;\n                    letter-spacing: 0px;\n                }\n\n                div#ays-quiz-container-9 .ays_questtion_explanation *:not(strong) {\n                    text-transform:none;\n                    text-decoration: none;\n                    letter-spacing: 0px;\n                }\n\n                div#ays-quiz-container-9 .right_answer_text *:not(strong) {\n                    text-transform:none;\n                    text-decoration: none;\n                    letter-spacing: 0px;\n                }\n\n                div#ays-quiz-container-9 .wrong_answer_text *:not(strong) {\n                    text-transform:none;\n                    text-decoration: none;\n              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Thorax F\u0153tal","description":"","quiz_image":"","quiz_category_id":"1","question_ids":"281,280,279,278,277,276,275,274,273,272,271,270,269,268,267,266,265,264,263,262,261,260,259,258,257,256,255,254,253,252,251,250,249,248,247,246,245,244,243,242,241,240,239,238,237,236,235,234,233,232,231,230,229,228,227,226","ordering":"9","published":"1","intervals":null,"quiz_url":"","author_id":"0","custom_post_id":null,"quiz_animation_top":100,"quiz_enable_animation_top":"on"}';\n        <\/script>\n                    <input type='hidden' name='quiz_id' value='9'\/>\n                    <input type='hidden' name='start_date' class='ays-start-date'\/>\n                <\/form><\/div>\n                            <\/div>\n                            <\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-3daab64 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"3daab64\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-ad3960f\" data-id=\"ad3960f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-9b984c3 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"9b984c3\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-7c1aae1\" data-id=\"7c1aae1\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2bf23d9 elementor-widget elementor-widget-text-editor\" data-id=\"2bf23d9\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: left;\">QUESTIONS \u00c0 R\u00c9PONSES COURTES<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e1f22f6 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"e1f22f6\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-ac04a8e elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"ac04a8e\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-4d44bbe\" data-id=\"4d44bbe\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d470a27 elementor-widget elementor-widget-toggle\" data-id=\"d470a27\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2221\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-2221\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">1. Quels sont les rep\u00e8res anatomiques essentiels en coupe axiale \u00e9chographique du thorax f\u0153tal ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2221\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-2221\"><p>\u2705 <strong>R\u00e9ponse :<\/strong><br \/>La <strong>coupe axiale<\/strong> est fondamentale pour l\u2019analyse du thorax f\u0153tal. Elle permet d\u2019identifier les <strong>deux poumons<\/strong>, qui doivent \u00eatre sym\u00e9triques et homog\u00e8nes, ainsi que le <strong>c\u0153ur<\/strong>, dont l\u2019apex doit normalement \u00eatre dirig\u00e9 vers la gauche. Le <strong>diaphragme<\/strong> est visible comme une ligne hyper\u00e9chog\u00e8ne s\u00e9parant le thorax de l\u2019abdomen. La <strong>trach\u00e9e<\/strong> peut \u00eatre identifi\u00e9e sous forme d\u2019une structure an\u00e9chog\u00e8ne m\u00e9diane. En cas de hernie diaphragmatique cong\u00e9nitale, on peut observer un d\u00e9placement du c\u0153ur et la pr\u00e9sence d\u2019organes abdominaux dans le thorax, ce qui aide \u00e0 poser le diagnostic.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2222\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-2222\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">2. Comment \u00e9volue l\u2019\u00e9chog\u00e9nicit\u00e9 pulmonaire au cours de la grossesse ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2222\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-2222\"><p>\u2705 <strong>R\u00e9ponse :<\/strong><br \/>L\u2019\u00e9chog\u00e9nicit\u00e9 pulmonaire varie au cours du d\u00e9veloppement f\u0153tal. Au <strong>premier trimestre<\/strong>, les poumons sont <strong>hypo\u00e9chog\u00e8nes<\/strong>, proches de l\u2019\u00e9chog\u00e9nicit\u00e9 du liquide amniotique. Au <strong>deuxi\u00e8me trimestre<\/strong>, leur \u00e9chog\u00e9nicit\u00e9 augmente progressivement en raison de la croissance des bronchioles terminales et du d\u00e9veloppement du tissu conjonctif. Au <strong>troisi\u00e8me trimestre<\/strong>, les poumons deviennent <strong>plus hyper\u00e9chog\u00e8nes<\/strong> par rapport au foie, traduisant une meilleure diff\u00e9renciation alv\u00e9olaire. Une \u00e9chog\u00e9nicit\u00e9 anormalement \u00e9lev\u00e9e ou asym\u00e9trique peut sugg\u00e9rer une anomalie pulmonaire, comme une maladie ad\u00e9nomato\u00efde kystique pulmonaire (MAKP).<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2223\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-2223\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">3. Quels sont les signes \u00e9chographiques \u00e9vocateurs d\u2019une hernie diaphragmatique cong\u00e9nitale ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2223\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-2223\"><p>\u2705 <strong>R\u00e9ponse :<\/strong><br \/>Plusieurs signes \u00e9chographiques permettent de diagnostiquer une <strong>hernie diaphragmatique cong\u00e9nitale (HDC)<\/strong>. Le plus \u00e9vocateur est le <strong>d\u00e9placement du c\u0153ur<\/strong> vers le c\u00f4t\u00e9 oppos\u00e9 \u00e0 la hernie. On peut \u00e9galement observer la <strong>pr\u00e9sence d\u2019organes abdominaux dans le thorax<\/strong>, notamment l\u2019estomac (HDC gauche) ou le foie (HDC droite). L\u2019absence de continuit\u00e9 du <strong>diaphragme<\/strong> est un autre signe cl\u00e9. De plus, un <strong>hydramnios<\/strong> peut \u00eatre pr\u00e9sent en raison de la compression de l\u2019\u0153sophage emp\u00eachant la d\u00e9glutition du liquide amniotique.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2224\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-2224\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">4. Quelle est l\u2019utilit\u00e9 du Lung-to-Head Ratio (LHR) en \u00e9chographie thoracique f\u0153tale ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2224\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-2224\"><p>\u2705 <strong>R\u00e9ponse :<\/strong><br \/>Le <strong>LHR (Lung-to-Head Ratio)<\/strong> est un param\u00e8tre \u00e9chographique utilis\u00e9 pour estimer la <strong>s\u00e9v\u00e9rit\u00e9 de l\u2019hypoplasie pulmonaire<\/strong>, notamment en cas de hernie diaphragmatique. Il se calcule en divisant la <strong>surface pulmonaire controlat\u00e9rale<\/strong> (le poumon non affect\u00e9 par la hernie) par le <strong>p\u00e9rim\u00e8tre c\u00e9phalique<\/strong>. Un <strong>LHR &gt; 45%<\/strong> est associ\u00e9 \u00e0 un bon pronostic, tandis qu\u2019un <strong>LHR &lt; 25%<\/strong> indique un risque \u00e9lev\u00e9 d\u2019hypoplasie pulmonaire s\u00e9v\u00e8re et de complications postnatales. Ce param\u00e8tre est essentiel pour orienter la prise en charge et d\u00e9cider d\u2019une \u00e9ventuelle intervention pr\u00e9natale comme l\u2019occlusion trach\u00e9ale f\u0153toscopique (FETO).<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2225\" class=\"elementor-tab-title\" data-tab=\"5\" role=\"button\" aria-controls=\"elementor-tab-content-2225\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">5. Comment identifier une s\u00e9questration pulmonaire en \u00e9chographie ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2225\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"5\" role=\"region\" aria-labelledby=\"elementor-tab-title-2225\"><p>\u2705 <strong>R\u00e9ponse :<\/strong><br \/>La <strong>s\u00e9questration pulmonaire<\/strong> se manifeste en \u00e9chographie comme une <strong>masse pulmonaire hyper\u00e9chog\u00e8ne<\/strong>, g\u00e9n\u00e9ralement situ\u00e9e dans le lobe inf\u00e9rieur du poumon gauche. Pour confirmer le diagnostic, le <strong>Doppler couleur<\/strong> est utilis\u00e9 afin de d\u00e9tecter la pr\u00e9sence d\u2019un <strong>vaisseau art\u00e9riel syst\u00e9mique anormal<\/strong> issu de l\u2019aorte thoracique ou abdominale. Contrairement \u00e0 une maladie ad\u00e9nomato\u00efde kystique pulmonaire (MAKP), la s\u00e9questration pulmonaire ne contient <strong>pas de kystes visibles<\/strong>.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2226\" class=\"elementor-tab-title\" data-tab=\"6\" role=\"button\" aria-controls=\"elementor-tab-content-2226\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">6. Quels sont les signes \u00e9chographiques d\u2019un chylothorax f\u0153tal ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2226\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"6\" role=\"region\" aria-labelledby=\"elementor-tab-title-2226\"><p>\u2705 <strong>R\u00e9ponse :<\/strong><br \/>Le <strong>chylothorax f\u0153tal<\/strong> se caract\u00e9rise par un <strong>\u00e9panchement pleural an\u00e9chog\u00e8ne<\/strong>, souvent bilat\u00e9ral. Il peut provoquer une <strong>compression pulmonaire<\/strong>, entra\u00eenant une hypoplasie pulmonaire si l\u2019\u00e9panchement est massif et persistant. Dans certains cas, il est associ\u00e9 \u00e0 un <strong>hydrops f\u0153tal<\/strong>, marqu\u00e9 par la pr\u00e9sence d\u2019un <strong>\u00e9panchement p\u00e9ricardique, d\u2019une ascite et d\u2019un \u0153d\u00e8me cutan\u00e9<\/strong>.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2227\" class=\"elementor-tab-title\" data-tab=\"7\" role=\"button\" aria-controls=\"elementor-tab-content-2227\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">7. Pourquoi l\u2019\u00e9chographie est-elle utilis\u00e9e pour surveiller les \u00e9panchements pleuraux ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2227\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"7\" role=\"region\" aria-labelledby=\"elementor-tab-title-2227\"><p>\u2705 <strong>R\u00e9ponse :<\/strong><br \/>L\u2019\u00e9chographie permet de <strong>quantifier l\u2019\u00e9panchement pleural<\/strong>, d\u2019\u00e9valuer son <strong>impact sur la fonction pulmonaire et cardiaque<\/strong>, et de guider d\u2019\u00e9ventuelles interventions pr\u00e9natales. En cas d\u2019\u00e9panchement volumineux, une <strong>ponction pleurale f\u0153tale (thoracocent\u00e8se)<\/strong> peut \u00eatre r\u00e9alis\u00e9e sous guidage \u00e9chographique. Si l\u2019\u00e9panchement r\u00e9cidive, la pose d\u2019un <strong>shunt pleuro-amniotique<\/strong> peut \u00eatre envisag\u00e9e pour am\u00e9liorer le pronostic respiratoire n\u00e9onatal.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-0e29c08\" data-id=\"0e29c08\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-078f63b elementor-widget elementor-widget-toggle\" data-id=\"078f63b\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-7921\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-7921\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">8. Comment diff\u00e9rencier une maladie ad\u00e9nomato\u00efde kystique pulmonaire (MAKP) d\u2019une s\u00e9questration pulmonaire en \u00e9chographie ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-7921\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-7921\"><p>\u2705 <strong>R\u00e9ponse :<\/strong><br \/>La <strong>MAKP<\/strong> se pr\u00e9sente sous forme d\u2019une <strong>masse hyper\u00e9chog\u00e8ne contenant des kystes<\/strong> de tailles variables, alors que la <strong>s\u00e9questration pulmonaire<\/strong> est une <strong>masse homog\u00e8ne sans kystes<\/strong>. Le Doppler est indispensable : la s\u00e9questration pulmonaire poss\u00e8de une <strong>vascularisation syst\u00e9mique anormale<\/strong>, tandis que la MAKP est vascularis\u00e9e par la circulation pulmonaire normale.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-7922\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-7922\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">9. Quel est l\u2019int\u00e9r\u00eat du mode M en \u00e9chographie thoracique f\u0153tale ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-7922\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-7922\"><p>\u2705 <strong>R\u00e9ponse :<\/strong><br \/>Le <strong>mode M<\/strong> permet d\u2019\u00e9tudier le <strong>mouvement du diaphragme<\/strong>, essentiel pour diagnostiquer une <strong>paralysie diaphragmatique<\/strong>. Une paralysie diaphragmatique se manifeste par un <strong>mouvement paradoxal<\/strong> du diaphragme : il se soul\u00e8ve lors de l\u2019inspiration au lieu de s\u2019abaisser. Cette anomalie peut \u00eatre associ\u00e9e \u00e0 une compression nerveuse ou une anomalie cong\u00e9nitale du diaphragme.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-7923\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-7923\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">10. Quels sont les signes \u00e9chographiques \u00e9vocateurs d\u2019une masse m\u00e9diastinale f\u0153tale ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-7923\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-7923\"><p>\u2705 <strong>R\u00e9ponse :<\/strong><br \/>Une <strong>masse m\u00e9diastinale<\/strong> peut appara\u00eetre en \u00e9chographie comme une <strong>structure hyper\u00e9chog\u00e8ne, mixte ou an\u00e9chog\u00e8ne<\/strong>, selon sa nature (t\u00e9ratome, kyste bronchog\u00e9nique, s\u00e9questration m\u00e9diastinale). Elle peut provoquer une <strong>d\u00e9viation du c\u0153ur et des gros vaisseaux<\/strong>, un <strong>hydramnios<\/strong> (par compression de l\u2019\u0153sophage) et une <strong>hypoplasie pulmonaire<\/strong> en cas de compression pulmonaire importante. Le <strong>Doppler couleur<\/strong> permet de pr\u00e9ciser la vascularisation, aidant \u00e0 diff\u00e9rencier une s\u00e9questration m\u00e9diastinale d\u2019une autre masse.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-7924\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-7924\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">11. Comment diff\u00e9rencier une hernie diaphragmatique gauche d\u2019une hernie diaphragmatique droite en \u00e9chographie ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-7924\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-7924\"><p>\u2705 <strong>R\u00e9ponse :<\/strong><br \/>Une <strong>hernie diaphragmatique gauche (HDCG)<\/strong> est plus fr\u00e9quente et se manifeste par la pr\u00e9sence de <strong>l\u2019estomac et\/ou des anses intestinales dans l\u2019h\u00e9mithorax gauche<\/strong>, souvent associ\u00e9e \u00e0 une <strong>d\u00e9viation du c\u0153ur vers la droite<\/strong>. Une <strong>hernie diaphragmatique droite (HDCD)<\/strong> est plus difficile \u00e0 diagnostiquer car le foie peut masquer l\u2019anomalie. Elle est suspect\u00e9e en cas de <strong>d\u00e9viation cardiaque vers la gauche<\/strong> et de <strong>visualisation d\u2019une structure h\u00e9patique en position thoracique<\/strong>, avec un alignement anormal de la veine ombilicale et du canal d\u2019Arantius.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-7925\" class=\"elementor-tab-title\" data-tab=\"5\" role=\"button\" aria-controls=\"elementor-tab-content-7925\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">12. Quel est le r\u00f4le de l\u2019\u00e9chographie dans la surveillance d\u2019un hydramnios en cas de pathologie thoracique f\u0153tale ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-7925\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"5\" role=\"region\" aria-labelledby=\"elementor-tab-title-7925\"><p>\u2705 <strong>R\u00e9ponse :<\/strong><br \/>L\u2019\u00e9chographie permet d\u2019\u00e9valuer l\u2019\u00e9volution de l\u2019<strong>hydramnios<\/strong>, souvent secondaire \u00e0 une <strong>compression de l\u2019\u0153sophage<\/strong> (comme dans une HDC ou une tumeur m\u00e9diastinale). Elle aide \u00e0 surveiller l\u2019<strong>augmentation du volume pulmonaire<\/strong>, la <strong>d\u00e9viation des structures m\u00e9diastinales<\/strong> et les <strong>signes d\u2019insuffisance cardiaque f\u0153tale<\/strong>. Un hydramnios s\u00e9v\u00e8re peut n\u00e9cessiter une <strong>amnior\u00e9duction<\/strong> ou une prise en charge sp\u00e9cifique de la cause sous-jacente.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-7926\" class=\"elementor-tab-title\" data-tab=\"6\" role=\"button\" aria-controls=\"elementor-tab-content-7926\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">13. Quels crit\u00e8res \u00e9chographiques permettent de suspecter une atr\u00e9sie bronchique f\u0153tale ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-7926\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"6\" role=\"region\" aria-labelledby=\"elementor-tab-title-7926\"><p>\u2705 <strong>R\u00e9ponse :<\/strong><br \/>L\u2019<strong>atr\u00e9sie bronchique<\/strong> se manifeste en \u00e9chographie par une <strong>masse pulmonaire hyper\u00e9chog\u00e8ne<\/strong>, secondaire \u00e0 une r\u00e9tention de liquide dans le parenchyme pulmonaire distendu. Cette anomalie est souvent unilat\u00e9rale, sans kystes visibles. On observe fr\u00e9quemment une <strong>d\u00e9viation du m\u00e9diastin<\/strong>, pouvant entra\u00eener une compression pulmonaire controlat\u00e9rale. Le <strong>Doppler couleur<\/strong> montre une vascularisation pulmonaire normale, ce qui aide \u00e0 diff\u00e9rencier cette anomalie d\u2019une s\u00e9questration pulmonaire.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-7927\" class=\"elementor-tab-title\" data-tab=\"7\" role=\"button\" aria-controls=\"elementor-tab-content-7927\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">14. Comment l\u2019\u00e9chographie influence-t-elle la prise en charge obst\u00e9tricale et n\u00e9onatale des pathologies thoraciques f\u0153tales ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-7927\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"7\" role=\"region\" aria-labelledby=\"elementor-tab-title-7927\"><p>\u2705 <strong>R\u00e9ponse :<\/strong><br \/>L\u2019\u00e9chographie permet d\u2019\u00e9valuer la <strong>gravit\u00e9 des anomalies thoraciques<\/strong>, ce qui influence la <strong>planification de l\u2019accouchement et la prise en charge n\u00e9onatale<\/strong>. En cas de <strong>l\u00e9sions s\u00e9v\u00e8res avec compression pulmonaire et m\u00e9diastinale<\/strong>, un <strong>accouchement en centre de niveau III<\/strong> est recommand\u00e9 pour assurer une prise en charge n\u00e9onatale sp\u00e9cialis\u00e9e (ventilation, chirurgie). Certaines anomalies (HDC s\u00e9v\u00e8re, masses m\u00e9diastinales volumineuses) peuvent justifier une <strong>c\u00e9sarienne programm\u00e9e<\/strong> pour minimiser le stress n\u00e9onatal et optimiser les soins postnataux imm\u00e9diats.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-02c1236 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"02c1236\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-66bce04\" data-id=\"66bce04\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-6cf0e1d\" data-id=\"6cf0e1d\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-92c8785 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"92c8785\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-83d0e58\" data-id=\"83d0e58\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-cd64d3b elementor-widget elementor-widget-text-editor\" data-id=\"cd64d3b\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>\u00c9TUDES DE CAS FICTIFS<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-158cf8b elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"158cf8b\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-84acfbb elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"84acfbb\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-894a70f\" data-id=\"894a70f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-f3adcbf elementor-widget elementor-widget-image\" data-id=\"f3adcbf\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"2560\" height=\"1106\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-cas-fictifs.jpg\" class=\"attachment-full size-full wp-image-5142\" alt=\"\" srcset=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-cas-fictifs.jpg 2560w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-cas-fictifs-300x130.jpg 300w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-cas-fictifs-1024x442.jpg 1024w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-cas-fictifs-768x332.jpg 768w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-cas-fictifs-1536x664.jpg 1536w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-cas-fictifs-2048x885.jpg 2048w\" sizes=\"(max-width: 2560px) 100vw, 2560px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-165c4d1 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"165c4d1\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-06184de\" data-id=\"06184de\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b3872f4 elementor-widget elementor-widget-toggle\" data-id=\"b3872f4\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1881\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-1881\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas 1 : Une d\u00e9couverte fortuite lors de l\u2019\u00e9chographie morphologique<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1881\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-1881\"><p><strong>Contexte :<\/strong><br \/>Une patiente de <strong>28 ans, primigeste<\/strong>, est adress\u00e9e pour une \u00e9chographie morphologique de routine \u00e0 <strong>22 SA<\/strong>. L\u2019\u00e9chographie montre une <strong>l\u00e9sion hyperechog\u00e8ne dans le champ pulmonaire gauche<\/strong>, sans d\u00e9placement m\u00e9diastinal apparent.<\/p><p><strong>Questions :<\/strong><\/p><ol><li>Quel est le diagnostic diff\u00e9rentiel principal ?<\/li><li>Quels examens compl\u00e9mentaires recommandez-vous ?<\/li><li>Quelle est la conduite \u00e0 tenir pour le suivi pr\u00e9natal ?<\/li><\/ol><p><strong>R\u00e9ponses :<\/strong><\/p><ol><li><strong>Diagnostic diff\u00e9rentiel :<\/strong><ul><li>Maladie ad\u00e9nomato\u00efde kystique pulmonaire (MAKP)<\/li><li>S\u00e9questration pulmonaire<\/li><li>Emphys\u00e8me lobaire cong\u00e9nital<\/li><li>Kyste bronchog\u00e9nique<\/li><\/ul><\/li><li><strong>Examens compl\u00e9mentaires :<\/strong><ul><li>Doppler couleur pour rechercher une <strong>vascularisation syst\u00e9mique<\/strong> (en faveur d\u2019une s\u00e9questration).<\/li><li>\u00c9valuation du <strong>Lung-to-Head Ratio (LHR)<\/strong> pour estimer le risque d\u2019hypoplasie pulmonaire.<\/li><li>IRM f\u0153tale si la l\u00e9sion est volumineuse pour pr\u00e9ciser le volume pulmonaire restant.<\/li><\/ul><\/li><li><strong>Conduite \u00e0 tenir :<\/strong><ul><li><strong>Suivi \u00e9chographique mensuel<\/strong> pour \u00e9valuer l\u2019\u00e9volution de la masse.<\/li><li><strong>Pas d\u2019intervention pr\u00e9natale<\/strong> en l\u2019absence de compression m\u00e9diastinale ou d\u2019hydrops.<\/li><li>Consultation avec un centre de r\u00e9f\u00e9rence pour discuter de la n\u00e9cessit\u00e9 d\u2019une r\u00e9section postnatale.<\/li><\/ul><\/li><\/ol><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1882\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-1882\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas 2 : Une anomalie pulmonaire associ\u00e9e \u00e0 un hydramnios<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1882\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-1882\"><p><strong>Contexte :<\/strong><br \/>Une patiente de <strong>32 ans, G3P1<\/strong>, est adress\u00e9e \u00e0 <strong>26 SA<\/strong> pour un <strong>hydramnios s\u00e9v\u00e8re (AFI = 27 cm)<\/strong>. L\u2019\u00e9chographie montre une <strong>masse kystique pulmonaire gauche<\/strong> avec <strong>d\u00e9placement du c\u0153ur \u00e0 droite<\/strong>.<\/p><p><strong>Questions :<\/strong><\/p><ol><li>Quel est le diagnostic le plus probable ?<\/li><li>Quels \u00e9l\u00e9ments \u00e9chographiques permettent d\u2019affiner le pronostic ?<\/li><li>Quel est le suivi recommand\u00e9 ?<\/li><\/ol><p><strong>R\u00e9ponses :<\/strong><\/p><ol><li><strong>Diagnostic probable :<\/strong><ul><li>Maladie ad\u00e9nomato\u00efde kystique pulmonaire macrokystique (MAKP type I).<\/li><\/ul><\/li><li><strong>\u00c9l\u00e9ments pronostiques :<\/strong><ul><li><strong>LHR<\/strong> : &lt; 1 est un facteur de mauvais pronostic.<\/li><li><strong>Pr\u00e9sence d\u2019une ascite ou d\u2019un hydramnios s\u00e9v\u00e8re<\/strong>, sugg\u00e9rant un risque de compression m\u00e9diastinale.<\/li><li><strong>D\u00e9placement du c\u0153ur<\/strong> : plus il est important, plus la s\u00e9v\u00e9rit\u00e9 de l\u2019hypoplasie pulmonaire est \u00e9lev\u00e9e.<\/li><\/ul><\/li><li><strong>Suivi recommand\u00e9 :<\/strong><ul><li>Surveillance \u00e9chographique toutes les <strong>2 semaines<\/strong> pour \u00e9valuer l\u2019\u00e9volution.<\/li><li>Consultation en <strong>centre de m\u00e9decine f\u0153tale<\/strong> pour discuter d\u2019une \u00e9ventuelle <strong>r\u00e9duction kystique in utero<\/strong> (thoraco-amniodrainage).<\/li><li><strong>Planification d\u2019une naissance en centre tertiaire<\/strong> avec r\u00e9animation n\u00e9onatale et chirurgie p\u00e9diatrique.<\/li><\/ul><\/li><\/ol><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1883\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-1883\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas 3 : Une hernie diaphragmatique asymptomatique ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1883\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-1883\"><p><strong>Contexte :<\/strong><br \/>Lors d\u2019une \u00e9chographie de <strong>d\u00e9pistage \u00e0 24 SA<\/strong>, une image an\u00e9chog\u00e8ne est observ\u00e9e dans le thorax gauche avec <strong>disparition de l\u2019estomac intra-abdominal<\/strong>.<\/p><p><strong>Questions :<\/strong><\/p><ol><li>Quel est le diagnostic le plus probable ?<\/li><li>Quels sont les \u00e9l\u00e9ments \u00e9chographiques d\u00e9terminants ?<\/li><li>Quelle est la prise en charge obst\u00e9tricale recommand\u00e9e ?<\/li><\/ol><p><strong>R\u00e9ponses :<\/strong><\/p><ol><li><strong>Diagnostic probable :<\/strong><ul><li>Hernie diaphragmatique cong\u00e9nitale gauche.<\/li><\/ul><\/li><li><strong>\u00c9l\u00e9ments \u00e9chographiques cl\u00e9s :<\/strong><ul><li><strong>Position de l\u2019estomac intrathoracique<\/strong>.<\/li><li><strong>D\u00e9viation cardiaque vers la droite<\/strong>.<\/li><li><strong>LHR<\/strong> et position du foie (intra-thoracique = mauvais pronostic).<\/li><\/ul><\/li><li><strong>Prise en charge :<\/strong><ul><li>Surveillance \u00e9chographique <strong>toutes les 2 semaines<\/strong> pour \u00e9valuer la progression.<\/li><li>Consultation en centre de r\u00e9f\u00e9rence pour envisager un <strong>FETO (occlusion trach\u00e9ale f\u0153toscopique)<\/strong> si LHR bas.<\/li><li>Accouchement en <strong>centre de niveau III<\/strong> avec \u00e9quipe de chirurgie n\u00e9onatale.<\/li><\/ul><\/li><\/ol><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1884\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-1884\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas 4 : Un \u00e9panchement pleural isol\u00e9<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1884\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-1884\"><p><strong>Contexte :<\/strong><br \/>Une femme de <strong>29 ans, G2P1<\/strong>, est adress\u00e9e \u00e0 <strong>30 SA<\/strong> pour la d\u00e9couverte d\u2019un <strong>\u00e9panchement pleural bilat\u00e9ral mod\u00e9r\u00e9<\/strong>, sans signes d\u2019hydrops.<\/p><p><strong>Questions :<\/strong><\/p><ol><li>Quel est le diagnostic diff\u00e9rentiel ?<\/li><li>Quels examens compl\u00e9mentaires recommandez-vous ?<\/li><li>Quelle est la prise en charge pr\u00e9natale ?<\/li><\/ol><p><strong>R\u00e9ponses :<\/strong><\/p><ol><li><strong>Diagnostic diff\u00e9rentiel :<\/strong><ul><li>Chylothorax cong\u00e9nital.<\/li><li>Infection intra-ut\u00e9rine (CMV, parvovirus).<\/li><li>Malformation lymphatique thoracique.<\/li><\/ul><\/li><li><strong>Examens compl\u00e9mentaires :<\/strong><ul><li><strong>PCR CMV et parvovirus sur liquide amniotique<\/strong>.<\/li><li><strong>Doppler des veines ombilicales<\/strong> pour rechercher une anasarque d\u00e9butante.<\/li><\/ul><\/li><li><strong>Prise en charge :<\/strong><ul><li>Surveillance <strong>hebdomadaire<\/strong>.<\/li><li>Ponction pleurale si compression pulmonaire.<\/li><li>Discussion d\u2019un <strong>shunt pleuro-amniotique<\/strong> si r\u00e9cidive.<\/li><\/ul><\/li><\/ol><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1885\" class=\"elementor-tab-title\" data-tab=\"5\" role=\"button\" aria-controls=\"elementor-tab-content-1885\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas 5 : Une masse thoracique mal vascularis\u00e9e<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1885\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"5\" role=\"region\" aria-labelledby=\"elementor-tab-title-1885\"><p><strong>Contexte :<\/strong><br \/>Un f\u0153tus de <strong>26 SA<\/strong> pr\u00e9sente une <strong>masse hyper\u00e9chog\u00e8ne intrathoracique droite<\/strong> sans signe de compression m\u00e9diastinale ni d\u2019hydrops.<\/p><p><strong>Questions :<\/strong><\/p><ol><li>Quel diagnostic \u00e9voquez-vous ?<\/li><li>Comment diff\u00e9rencier une s\u00e9questration pulmonaire d\u2019une MAKP ?<\/li><li>Quelle est la prise en charge postnatale ?<\/li><\/ol><p><strong>R\u00e9ponses :<\/strong><\/p><ol><li><strong>Diagnostic probable :<\/strong><ul><li>S\u00e9questration pulmonaire.<\/li><\/ul><\/li><li><strong>Diff\u00e9renciation par Doppler :<\/strong><ul><li><strong>S\u00e9questration<\/strong> : vascularisation par <strong>une art\u00e8re syst\u00e9mique<\/strong>.<\/li><li><strong>MAKP<\/strong> : absence de vascularisation syst\u00e9mique propre.<\/li><\/ul><\/li><li><strong>Prise en charge postnatale :<\/strong><ul><li>Surveillance et <strong>r\u00e9section chirurgicale apr\u00e8s naissance<\/strong> si l\u00e9sions symptomatiques.<\/li><\/ul><\/li><\/ol><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-d0a8b6c\" data-id=\"d0a8b6c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-557fdc6 elementor-widget elementor-widget-toggle\" data-id=\"557fdc6\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-8961\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-8961\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas 6 : Une masse pulmonaire avec vascularisation anormale<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-8961\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-8961\"><p><strong>Contexte :<\/strong><br \/>Une patiente de <strong>30 ans, G2P1<\/strong>, est adress\u00e9e \u00e0 <strong>24 SA<\/strong> pour la d\u00e9couverte d\u2019une <strong>masse hyper\u00e9chog\u00e8ne pulmonaire droite<\/strong>, mesurant <strong>25 mm<\/strong>, avec une vascularisation syst\u00e9mique d\u00e9tect\u00e9e au Doppler.<\/p><p><strong>Questions :<\/strong><\/p><ol><li><p>Quel est le diagnostic le plus probable ?<\/p><\/li><li><p>Comment diff\u00e9rencier cette masse d\u2019une autre malformation pulmonaire ?<\/p><\/li><li><p>Quelle est la prise en charge pr\u00e9natale recommand\u00e9e ?<\/p><\/li><\/ol><p><strong>R\u00e9ponses :<\/strong><\/p><ol><li><p><strong>Diagnostic probable :<\/strong><\/p><ul><li><p><strong>S\u00e9questration pulmonaire intralobaire<\/strong>, en raison de la <strong>vascularisation syst\u00e9mique anormale<\/strong> d\u00e9tect\u00e9e en Doppler couleur.<\/p><\/li><\/ul><\/li><li><p><strong>Diff\u00e9renciation des autres anomalies pulmonaires :<\/strong><\/p><ul><li><p><strong>MAKP<\/strong> : pr\u00e9sence de <strong>kystes<\/strong> et absence de vascularisation syst\u00e9mique propre.<\/p><\/li><li><p><strong>Emphys\u00e8me lobaire cong\u00e9nital<\/strong> : hyperinflation pulmonaire mais <strong>sans vascularisation syst\u00e9mique anormale<\/strong>.<\/p><\/li><\/ul><\/li><li><p><strong>Prise en charge pr\u00e9natale :<\/strong><\/p><ul><li><p><strong>Suivi \u00e9chographique mensuel<\/strong> pour surveiller la croissance de la masse et l\u2019apparition d\u2019un \u00e9ventuel hydrops.<\/p><\/li><li><p>IRM f\u0153tale pour <strong>quantifier le volume pulmonaire restant<\/strong> et pr\u00e9ciser la structure de la masse.<\/p><\/li><li><p>Discussion en <strong>centre de r\u00e9f\u00e9rence<\/strong> pour planifier une \u00e9ventuelle chirurgie postnatale.<\/p><\/li><\/ul><\/li><\/ol><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-8962\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-8962\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas 7 : Un d\u00e9placement cardiaque progressif<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-8962\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-8962\"><p><strong>Contexte :<\/strong><br \/>Lors du suivi \u00e9chographique d\u2019une grossesse \u00e0 <strong>27 SA<\/strong>, un <strong>d\u00e9placement progressif du c\u0153ur vers la droite<\/strong> est observ\u00e9. Une <strong>masse pulmonaire homog\u00e8ne, hyper\u00e9chog\u00e8ne, sans vascularisation anormale<\/strong> est d\u00e9tect\u00e9e.<\/p><p><strong>Questions :<\/strong><\/p><ol><li><p>Quel est le diagnostic le plus probable ?<\/p><\/li><li><p>Quels sont les \u00e9l\u00e9ments de gravit\u00e9 \u00e0 rechercher ?<\/p><\/li><li><p>Quelle est la prise en charge obst\u00e9tricale recommand\u00e9e ?<\/p><\/li><\/ol><p><strong>R\u00e9ponses :<\/strong><\/p><ol><li><p><strong>Diagnostic probable :<\/strong><\/p><ul><li><p><strong>Maladie ad\u00e9nomato\u00efde kystique pulmonaire (MAKP) de type III<\/strong>, en raison de l\u2019aspect hyper\u00e9chog\u00e8ne homog\u00e8ne.<\/p><\/li><\/ul><\/li><li><p><strong>\u00c9l\u00e9ments de gravit\u00e9 :<\/strong><\/p><ul><li><p><strong>Hydrops f\u0153tal<\/strong> (ascite, \u00e9panchement pleural, \u0153d\u00e8me cutan\u00e9).<\/p><\/li><li><p><strong>Compression du retour veineux syst\u00e9mique<\/strong> entra\u00eenant une insuffisance cardiaque f\u0153tale.<\/p><\/li><\/ul><\/li><li><p><strong>Prise en charge obst\u00e9tricale :<\/strong><\/p><ul><li><p>Surveillance \u00e9chographique <strong>toutes les 2 semaines<\/strong>.<\/p><\/li><li><p>Si signes de compression s\u00e9v\u00e8re, discussion d\u2019un <strong>shunt thoraco-amniotique<\/strong>.<\/p><\/li><li><p>Naissance programm\u00e9e dans un <strong>centre de niveau III<\/strong> avec service de chirurgie n\u00e9onatale.<\/p><\/li><\/ul><\/li><\/ol><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-8963\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-8963\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas 8 : Un \u00e9panchement pleural asym\u00e9trique<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-8963\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-8963\"><p><strong>Contexte :<\/strong><br \/>Une femme enceinte de <strong>29 ans, G1P0<\/strong>, est r\u00e9f\u00e9r\u00e9e \u00e0 <strong>28 SA<\/strong> pour un <strong>\u00e9panchement pleural droit isol\u00e9<\/strong>, mod\u00e9r\u00e9, sans autres anomalies d\u00e9tect\u00e9es.<\/p><p><strong>Questions :<\/strong><\/p><ol><li><p>Quel est le diagnostic diff\u00e9rentiel ?<\/p><\/li><li><p>Quels examens compl\u00e9mentaires recommandez-vous ?<\/p><\/li><li><p>Quelle est la conduite \u00e0 tenir ?<\/p><\/li><\/ol><p><strong>R\u00e9ponses :<\/strong><\/p><ol><li><p><strong>Diagnostic diff\u00e9rentiel :<\/strong><\/p><ul><li><p><strong>Chylothorax cong\u00e9nital<\/strong> (cause la plus fr\u00e9quente).<\/p><\/li><li><p><strong>Infection cong\u00e9nitale<\/strong> (CMV, parvovirus B19).<\/p><\/li><li><p><strong>Tumeur m\u00e9diastinale<\/strong> (kyste bronchog\u00e9nique).<\/p><\/li><\/ul><\/li><li><p><strong>Examens compl\u00e9mentaires :<\/strong><\/p><ul><li><p>PCR CMV et parvovirus B19 sur <strong>liquide amniotique<\/strong>.<\/p><\/li><li><p>Doppler veineux pour rechercher une <strong>anasarque d\u00e9butante<\/strong>.<\/p><\/li><\/ul><\/li><li><p><strong>Conduite \u00e0 tenir :<\/strong><\/p><ul><li><p>Surveillance \u00e9chographique <strong>toutes les 2 semaines<\/strong>.<\/p><\/li><li><p>Ponction pleurale si <strong>augmentation rapide de l\u2019\u00e9panchement<\/strong>.<\/p><\/li><li><p>Discussion d\u2019un <strong>shunt pleuro-amniotique<\/strong> si r\u00e9cidive ou impact h\u00e9modynamique.<\/p><\/li><\/ul><\/li><\/ol><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-8964\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-8964\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas 9 : Une hernie diaphragmatique isol\u00e9e ou syndromique ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-8964\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-8964\"><p><strong>Contexte :<\/strong><br \/>Un f\u0153tus de <strong>25 SA<\/strong> est diagnostiqu\u00e9 avec une <strong>hernie diaphragmatique gauche<\/strong> et un <strong>volume pulmonaire r\u00e9duit<\/strong>. L\u2019<strong>examen morphologique est normal<\/strong>.<\/p><p><strong>Questions :<\/strong><\/p><ol><li><p>Quelle est la premi\u00e8re \u00e9tape apr\u00e8s confirmation du diagnostic ?<\/p><\/li><li><p>Quels sont les principaux \u00e9l\u00e9ments pronostiques \u00e0 \u00e9valuer ?<\/p><\/li><li><p>Quel suivi recommandez-vous ?<\/p><\/li><\/ol><p><strong>R\u00e9ponses :<\/strong><\/p><ol><li><p><strong>Premi\u00e8re \u00e9tape :<\/strong><\/p><ul><li><p><strong>Amniocent\u00e8se<\/strong> pour rechercher une anomalie chromosomique (trisomie 18, syndrome de Pallister-Killian).<\/p><\/li><\/ul><\/li><li><p><strong>\u00c9l\u00e9ments pronostiques :<\/strong><\/p><ul><li><p><strong>LHR<\/strong> : un LHR &lt; <strong>1<\/strong> est associ\u00e9 \u00e0 un mauvais pronostic.<\/p><\/li><li><p><strong>Pr\u00e9sence du foie dans le thorax<\/strong> (aggrave l\u2019hypoplasie pulmonaire).<\/p><\/li><\/ul><\/li><li><p><strong>Suivi recommand\u00e9 :<\/strong><\/p><ul><li><p>Surveillance \u00e9chographique toutes les <strong>2 semaines<\/strong>.<\/p><\/li><li><p>IRM f\u0153tale pour pr\u00e9ciser le <strong>volume pulmonaire total<\/strong>.<\/p><\/li><li><p>Accouchement en <strong>centre de chirurgie n\u00e9onatale<\/strong>, avec discussion d\u2019un <strong>FETO (occlusion trach\u00e9ale f\u0153toscopique)<\/strong> si n\u00e9cessaire.<\/p><\/li><\/ul><\/li><\/ol><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-8965\" class=\"elementor-tab-title\" data-tab=\"5\" role=\"button\" aria-controls=\"elementor-tab-content-8965\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Cas 10 : Un kyste m\u00e9diastinal compressif<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-8965\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"5\" role=\"region\" aria-labelledby=\"elementor-tab-title-8965\"><p><strong>Contexte :<\/strong><br \/>\u00c0 <strong>30 SA<\/strong>, une \u00e9chographie morphologique montre une <strong>masse kystique an\u00e9chog\u00e8ne dans le m\u00e9diastin<\/strong>, avec <strong>d\u00e9viation trach\u00e9ale et cardiaque<\/strong>.<\/p><p><strong>Questions :<\/strong><\/p><ol><li><p>Quel est le diagnostic le plus probable ?<\/p><\/li><li><p>Quels examens permettent de pr\u00e9ciser ce diagnostic ?<\/p><\/li><li><p>Quelle est la prise en charge pr\u00e9natale et postnatale ?<\/p><\/li><\/ol><p><strong>R\u00e9ponses :<\/strong><\/p><ol><li><p><strong>Diagnostic probable :<\/strong><\/p><ul><li><p><strong>Kyste bronchog\u00e9nique m\u00e9diastinal<\/strong>.<\/p><\/li><\/ul><\/li><li><p><strong>Examens compl\u00e9mentaires :<\/strong><\/p><ul><li><p><strong>IRM f\u0153tale<\/strong> pour pr\u00e9ciser la localisation et les rapports avec la trach\u00e9e.<\/p><\/li><li><p><strong>\u00c9chographie Doppler<\/strong> pour exclure une s\u00e9questration pulmonaire associ\u00e9e.<\/p><\/li><\/ul><\/li><li><p><strong>Prise en charge pr\u00e9natale et postnatale :<\/strong><\/p><ul><li><p>Surveillance \u00e9chographique <strong>toutes les 3 semaines<\/strong> pour \u00e9valuer la compression.<\/p><\/li><li><p>Naissance en <strong>centre sp\u00e9cialis\u00e9<\/strong> avec \u00e9valuation n\u00e9onatale imm\u00e9diate.<\/p><\/li><li><p><strong>R\u00e9section chirurgicale postnatale<\/strong> si sympt\u00f4mes respiratoires ou compression des voies a\u00e9riennes.<\/p><\/li><\/ul><\/li><\/ol><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-a5969d1 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"a5969d1\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-1260fdd\" data-id=\"1260fdd\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-101caf4 elementor-widget elementor-widget-text-editor\" data-id=\"101caf4\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p style=\"text-align: left;\">PowerPoint Slides<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-06e53c0 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"06e53c0\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-c93b2a8 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"c93b2a8\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-a4e8d97\" data-id=\"a4e8d97\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2e51568 elementor-widget elementor-widget-image\" data-id=\"2e51568\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"2560\" height=\"1106\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-ppt-thorax-foetal.jpg\" class=\"attachment-full size-full wp-image-5132\" alt=\"\" srcset=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-ppt-thorax-foetal.jpg 2560w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-ppt-thorax-foetal-300x130.jpg 300w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-ppt-thorax-foetal-1024x442.jpg 1024w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-ppt-thorax-foetal-768x332.jpg 768w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-ppt-thorax-foetal-1536x664.jpg 1536w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-ppt-thorax-foetal-2048x885.jpg 2048w\" sizes=\"(max-width: 2560px) 100vw, 2560px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-4d60741 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"4d60741\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-ee986e5\" data-id=\"ee986e5\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8b26a85 elementor-widget elementor-widget-toggle\" data-id=\"8b26a85\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1451\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-1451\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Slide 1 : \u00c9chographie du thorax f\u0153tal : De l\u2019anatomie normale aux malformations complexes<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1451\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-1451\"><ul><li>Pr\u00e9sentation du cours<\/li><li>Objectifs p\u00e9dagogiques<\/li><li>Plan du cours<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1452\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-1452\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Slide 2 : Introduction \u00e0 l\u2019\u00e9chographie du thorax f\u0153tal. Objectifs du chapitre<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1452\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-1452\"><ul><li>Importance de l\u2019\u00e9chographie thoracique f\u0153tale<\/li><li>Indications principales<\/li><li>D\u00e9fis et limites diagnostiques<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1453\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-1453\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Slide 3 : Pourquoi l\u2019\u00e9chographie thoracique f\u0153tale ?<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1453\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-1453\"><ul><li>Diagnostic des malformations pulmonaires et diaphragmatiques<\/li><li>\u00c9valuation du d\u00e9veloppement pulmonaire<\/li><li>Orientation des d\u00e9cisions obst\u00e9tricales<\/li><li>Alternative \u00e0 l\u2019IRM en cas de contre-indication<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1454\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-1454\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Slide 4 : Techniques d\u2019imagerie utilis\u00e9es<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1454\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-1454\"><ul><li>Mode 2D (B-mode) : structure et morphologie<\/li><li>Doppler couleur : circulation sanguine<\/li><li>Mode M : mouvement du diaphragme<\/li><li>Mode 3D\/4D : visualisation volumique<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1455\" class=\"elementor-tab-title\" data-tab=\"5\" role=\"button\" aria-controls=\"elementor-tab-content-1455\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Slide 5 : Structures anatomiques du thorax f\u0153tal<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1455\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"5\" role=\"region\" aria-labelledby=\"elementor-tab-title-1455\"><ul><li>Poumons<\/li><li>Diaphragme<\/li><li>C\u0153ur et m\u00e9diastin<\/li><li>Cage thoracique<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1456\" class=\"elementor-tab-title\" data-tab=\"6\" role=\"button\" aria-controls=\"elementor-tab-content-1456\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Slide 6 : Coupes \u00e9chographiques essentielles<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1456\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"6\" role=\"region\" aria-labelledby=\"elementor-tab-title-1456\"><ul><li>Coupe axiale : \u00e9valuation globale<\/li><li>Coupe longitudinale parasagittale : analyse du diaphragme<\/li><li>Coupe coronale : sym\u00e9trie pulmonaire<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1457\" class=\"elementor-tab-title\" data-tab=\"7\" role=\"button\" aria-controls=\"elementor-tab-content-1457\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Slide 7 : D\u00e9veloppement pulmonaire<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1457\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"7\" role=\"region\" aria-labelledby=\"elementor-tab-title-1457\"><ul><li>Phase pseudoglandulaire (5-17 SA)<\/li><li>Phase canaliculaire (16-26 SA)<\/li><li>Phase sacculaire (24-36 SA)<\/li><li>Phase alv\u00e9olaire (apr\u00e8s 36 SA)<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1458\" class=\"elementor-tab-title\" data-tab=\"8\" role=\"button\" aria-controls=\"elementor-tab-content-1458\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Slide 8 : Analyse \u00e9chographique du d\u00e9veloppement pulmonaire<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1458\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"8\" role=\"region\" aria-labelledby=\"elementor-tab-title-1458\"><ul><li>Volume pulmonaire<\/li><li>Lung-to-Head Ratio (LHR)<\/li><li>Pr\u00e9sence d\u2019\u00e9panchements<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1459\" class=\"elementor-tab-title\" data-tab=\"9\" role=\"button\" aria-controls=\"elementor-tab-content-1459\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Slide 9 : Lung-to-Head Ratio (LHR)<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1459\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"9\" role=\"region\" aria-labelledby=\"elementor-tab-title-1459\"><ul><li>LHR &gt; 45% : bon pronostic<\/li><li>LHR 25-45% : pronostic interm\u00e9diaire<\/li><li>LHR &lt; 25% : risque \u00e9lev\u00e9 d\u2019hypoplasie pulmonaire<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-14510\" class=\"elementor-tab-title\" data-tab=\"10\" role=\"button\" aria-controls=\"elementor-tab-content-14510\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Slide 10 : Utilit\u00e9 du Doppler couleur<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-14510\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"10\" role=\"region\" aria-labelledby=\"elementor-tab-title-14510\"><ul><li>\u00c9valuation de la circulation pulmonaire<\/li><li>Identification des anomalies vasculaires<\/li><li>Diff\u00e9renciation des masses pulmonaires<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-a18f778\" data-id=\"a18f778\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-fbb8eda elementor-widget elementor-widget-toggle\" data-id=\"fbb8eda\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2631\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-2631\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Slide 11 : Hernie diaphragmatique cong\u00e9nitale (HDC)<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2631\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-2631\"><ul><li>D\u00e9placement du c\u0153ur<\/li><li>Pr\u00e9sence d\u2019organes abdominaux dans le thorax<\/li><li>Hypoplasie pulmonaire associ\u00e9e<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2632\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-2632\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Slide 12 : Maladie ad\u00e9nomato\u00efde kystique pulmonaire (MAKP)<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2632\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-2632\"><ul><li>Pr\u00e9sence de kystes pulmonaires<\/li><li>Hypoplasie pulmonaire possible<\/li><li>Risque de compression m\u00e9diastinale<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2633\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-2633\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Slide 13 : S\u00e9questration pulmonaire<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2633\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-2633\"><ul><li>Masse pulmonaire hyper\u00e9chog\u00e8ne<\/li><li>Vascularisation syst\u00e9mique anormale (Doppler couleur)<\/li><li>Absence de connexion bronchique<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2634\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-2634\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Slide 14 : Chylothorax et \u00e9panchements pleuraux<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2634\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-2634\"><ul><li>\u00c9panchement an\u00e9chog\u00e8ne<\/li><li>Compression pulmonaire<\/li><li>Hydrops f\u0153tal possible<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2635\" class=\"elementor-tab-title\" data-tab=\"5\" role=\"button\" aria-controls=\"elementor-tab-content-2635\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Slide 15 : T\u00e9ratomes m\u00e9diastinaux<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2635\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"5\" role=\"region\" aria-labelledby=\"elementor-tab-title-2635\"><ul><li>Masse mixte avec composantes solides et kystiques<\/li><li>D\u00e9viation m\u00e9diastinale<\/li><li>Pr\u00e9sence possible de calcifications<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2636\" class=\"elementor-tab-title\" data-tab=\"6\" role=\"button\" aria-controls=\"elementor-tab-content-2636\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Slide 16 : Surveillance \u00e9chographique<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2636\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"6\" role=\"region\" aria-labelledby=\"elementor-tab-title-2636\"><ul><li>Fr\u00e9quence des \u00e9chographies<\/li><li>\u00c9valuation de la progression de l\u2019anomalie<\/li><li>Planification de l\u2019accouchement<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2637\" class=\"elementor-tab-title\" data-tab=\"7\" role=\"button\" aria-controls=\"elementor-tab-content-2637\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Slide 17 : Prise en charge postnatale<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2637\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"7\" role=\"region\" aria-labelledby=\"elementor-tab-title-2637\"><ul><li>Intubation imm\u00e9diate si d\u00e9tresse respiratoire<\/li><li>Chirurgie en fonction de l\u2019\u00e9volution<\/li><li>Surveillance en soins intensifs n\u00e9onataux<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-2638\" class=\"elementor-tab-title\" data-tab=\"8\" role=\"button\" aria-controls=\"elementor-tab-content-2638\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Slide 18 : Synth\u00e8se et discussion<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-2638\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"8\" role=\"region\" aria-labelledby=\"elementor-tab-title-2638\"><ul><li>Importance du diagnostic \u00e9chographique<\/li><li>Impact sur la prise en charge obst\u00e9tricale et n\u00e9onatale<\/li><li>Questions et \u00e9changes<\/li><\/ul><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-2c9ed5e elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"2c9ed5e\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-8c2fb72\" data-id=\"8c2fb72\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-20da1dc elementor-widget elementor-widget-text-editor\" data-id=\"20da1dc\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Fiche-Synth\u00e8se<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1aa7158 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"1aa7158\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-0535b24 elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"0535b24\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d6dc6b2\" data-id=\"d6dc6b2\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-e474986 elementor-widget elementor-widget-text-editor\" data-id=\"e474986\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<ol><li><strong>Hernie Diaphragmatique Cong\u00e9nitale (HCD) :<\/strong><\/li><\/ol><ul><li><strong>Diagnostic et \u00e9valuation:<\/strong> Importance cruciale de l&#8217;\u00e9chographie pour le diagnostic et l&#8217;\u00e9valuation de la HCD.<\/li><li><strong>Facteurs pronostiques:LHR (Lung-to-Head Ratio):<\/strong> Technique de mesure, int\u00e9r\u00eat et limites. LHR observ\u00e9\/attendu (LHRo\/a) : calcul et interpr\u00e9tation. Les difficult\u00e9s de la mesure du LHR sont li\u00e9es \u00e0 la position f\u0153tale.<\/li><li><strong>Position de l&#8217;estomac:<\/strong> Classification de Cordier et corr\u00e9lation avec le pronostic. Grades de 1 \u00e0 4.<\/li><li><strong>IRM thoracique f\u0153tale:<\/strong> \u00c9valuation du volume pulmonaire et du volume h\u00e9patique.<\/li><li><strong>Autres:<\/strong> Hydramnios, d\u00e9viation m\u00e9diastinale, anomalies cardiaques associ\u00e9es.<\/li><li><strong>Prise en charge:<\/strong> N\u00e9cessit\u00e9 d&#8217;une prise en charge multidisciplinaire dans un centre sp\u00e9cialis\u00e9.<\/li><\/ul><p><strong>2 Malformations Pulmonaires Cong\u00e9nitales (MPC) :<\/strong><\/p><ul><li><strong>Divers types :<\/strong> Malformations Ad\u00e9nomato\u00efdes Kystiques Pulmonaires (MAKP), s\u00e9questrations pulmonaires, atr\u00e9sie bronchique, kyste neurent\u00e9rique.<\/li><li><strong>Diagnostic :<\/strong> L&#8217;\u00e9chographie est essentielle pour l&#8217;\u00e9valuation du retentissement local, r\u00e9gional et g\u00e9n\u00e9ral des MPC. \u00c9chog\u00e9nicit\u00e9, topographie et caract\u00e9ristiques des l\u00e9sions sont not\u00e9es \u00e0 chaque examen.<\/li><li><strong>\u00c9volution :<\/strong> Les MAKP et s\u00e9questrations connaissent une croissance jusqu\u2019\u00e0 30\u201332 semaines d\u2019am\u00e9norrh\u00e9e (SA), pour, le plus souvent, stagner ou r\u00e9gresser par la suite.<\/li><li><strong>Facteurs Pr\u00e9dictifs :<\/strong> Le CVR (Congenital pulmonary malformation volume ratio) diminue avec l&#8217;\u00e2ge gestationnel.<\/li><\/ul><ol start=\"3\"><li><strong> Syndrome de Pallister-Killian (SPK) :<\/strong><\/li><\/ol><ul><li><strong>Diagnostic:<\/strong> L\u2019examen de la face est aujourd\u2019hui plus accessible gr\u00e2ce \u00e0 l\u2019av\u00e8nement de l\u2019\u00e9chographie 3D.<\/li><li>Le SPK est caract\u00e9ris\u00e9 par un ph\u00e9notype facial particulier qui comprend un petit nez avec parfois une ag\u00e9n\u00e9sie des os propres du nez, une l\u00e8vre sup\u00e9rieure \u00e9paisse (l\u00e8vre de Pallister) et un profil plat.<\/li><\/ul><ol start=\"4\"><li><strong> Autres Pathologies Thoraciques F\u0153tales :<\/strong><\/li><\/ol><ul><li>Chylothorax : D\u00e9finition et incidence, prise en charge pr\u00e9natale.<\/li><\/ul><p><strong>Id\u00e9es\/Faits Importants<\/strong><\/p><ul><li><strong>L&#8217;importance de l&#8217;\u00e9chographie :<\/strong> L&#8217;\u00e9chographie est un outil essentiel pour le diagnostic pr\u00e9natal et l&#8217;\u00e9valuation des anomalies thoraciques f\u0153tales.<\/li><li><strong>Le LHR comme indicateur pronostique :<\/strong> La mesure du LHR (Lung-to-Head Ratio) est un outil pronostique important pour les HCD. Id\u00e9alement, la surface pulmonaire mesur\u00e9e controlat\u00e9rale \u00e0 la HCD doit \u00eatre proche de la sonde d\u2019\u00e9chographie et donc le f\u0153tus plac\u00e9 dos ant\u00e9rieur. Pour \u00e9viter les c\u00f4nes d\u2019ombres li\u00e9s aux c\u00f4tes, la sonde d\u2019\u00e9chographie doit \u00eatre parall\u00e8le aux c\u00f4tes du f\u0153tus, et donc, un maximum de 2 c\u00f4tes doit \u00eatre visible. L\u2019op\u00e9rateur sera sensible \u00e0 la visualisation correcte des contours pulmonaires afin de s\u2019assurer de la bonne position des calipers et s\u2019aidera des images en dynamique pour bien distinguer la limite du poumon de la paroi de l\u2019oreillette adjacente.<\/li><li><strong>La classification de Cordier pour la position de l&#8217;estomac :<\/strong> La classification de Cordier de la position de l&#8217;estomac est un indicateur pronostique pour les HCD gauches.<\/li><li><strong>Le r\u00f4le de l&#8217;IRM :<\/strong> L&#8217;IRM thoracique f\u0153tale est utilis\u00e9e pour \u00e9valuer le volume pulmonaire et le volume h\u00e9patique dans les HCD.<\/li><li><strong>Des facteurs pr\u00e9nataux influencent la morbidit\u00e9 gastro-intestinale :<\/strong> La position de l&#8217;estomac f\u0153tal est le seul pr\u00e9dicteur de la morbidit\u00e9 gastro-intestinale (GIM) \u00e0 2 ans.<\/li><\/ul>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-97bdf52 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"97bdf52\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-adf55ca\" data-id=\"adf55ca\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c4aa4ff elementor-widget elementor-widget-text-editor\" data-id=\"c4aa4ff\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Bibliographie<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-18d83aa elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"18d83aa\" data-element_type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-7ab355e elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"7ab355e\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d3f19b3\" data-id=\"d3f19b3\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c2b3a0d elementor-widget elementor-widget-image\" data-id=\"c2b3a0d\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"2560\" height=\"1106\" src=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-biblio.jpg\" class=\"attachment-full size-full wp-image-5158\" alt=\"\" srcset=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-biblio.jpg 2560w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-biblio-300x130.jpg 300w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-biblio-1024x442.jpg 1024w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-biblio-768x332.jpg 768w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-biblio-1536x664.jpg 1536w, http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/illust-biblio-2048x885.jpg 2048w\" sizes=\"(max-width: 2560px) 100vw, 2560px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"has_eae_slider elementor-section elementor-top-section elementor-element elementor-element-eccfb33 elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"eccfb33\" data-element_type=\"section\" data-settings=\"{&quot;_ha_eqh_enable&quot;:false}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-5d5dc4c\" data-id=\"5d5dc4c\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9029244 elementor-widget elementor-widget-toggle\" data-id=\"9029244\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1511\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-1511\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Prise en charge pr\u00e9natale des chylothorax R. Favre Archives de P\u00e9diatrie 2010;17:695-696<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1511\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-1511\"><p>Cet article traite du <strong>chylothorax cong\u00e9nital<\/strong>, un \u00e9panchement pleural f\u0153tal pouvant \u00eatre idiopathique ou secondaire \u00e0 une pathologie sous-jacente. L\u2019auteur analyse les diff\u00e9rentes strat\u00e9gies diagnostiques et th\u00e9rapeutiques disponibles en pr\u00e9natal pour optimiser la prise en charge et am\u00e9liorer le pronostic n\u00e9onatal.<\/p><p>L\u2019<strong>hydrothorax f\u0153tal<\/strong> peut \u00eatre <strong>primitif ou secondaire<\/strong> et a une incidence estim\u00e9e entre <strong>1\/10 000 et 1\/15 000 grossesses<\/strong>. Le diagnostic repose principalement sur l\u2019\u00e9chographie, qui met en \u00e9vidence un <strong>\u00e9panchement pleural uni ou bilat\u00e9ral<\/strong>, parfois associ\u00e9 \u00e0 un <strong>hydramnios et une compression pulmonaire<\/strong>. Le chylothorax est confirm\u00e9 par analyse du liquide pleural apr\u00e8s ponction, en identifiant un <strong>taux de triglyc\u00e9rides &gt; 1,1 mmol\/L et une pr\u00e9dominance de lymphocytes (&gt;80 %)<\/strong>.<\/p><p><strong>Strat\u00e9gies de prise en charge :<\/strong><\/p><ol><li><p><strong>Approche conservatrice<\/strong> :<\/p><ul><li><p>Indiqu\u00e9e pour les \u00e9panchements mod\u00e9r\u00e9s sans <strong>signes de compression s\u00e9v\u00e8re<\/strong>.<\/p><\/li><li><p>Taux de survie rapport\u00e9s entre <strong>73 et 100 %<\/strong>.<\/p><\/li><\/ul><\/li><li><p><strong>Ponction pleurale<\/strong> :<\/p><ul><li><p>Peut \u00eatre r\u00e9alis\u00e9e \u00e0 vis\u00e9e diagnostique et th\u00e9rapeutique.<\/p><\/li><li><p>Utilis\u00e9e pour soulager la compression thoracique et \u00e9valuer la capacit\u00e9 pulmonaire.<\/p><\/li><li><p>N\u00e9cessite parfois des ponctions it\u00e9ratives, avec un risque d\u2019anasarque et d\u2019hypoprot\u00e9in\u00e9mie.<\/p><\/li><\/ul><\/li><li><p><strong>Shunt pleuro-amniotique<\/strong> :<\/p><ul><li><p>Drainage permanent via un cath\u00e9ter pigtail sous guidage \u00e9chographique.<\/p><\/li><li><p>Permet une meilleure expansion pulmonaire et r\u00e9duit la r\u00e9cidive de l\u2019\u00e9panchement.<\/p><\/li><li><p>Taux de survie postnatale variant entre <strong>50 et 90 %<\/strong>, d\u00e9pendant de la pr\u00e9sence d\u2019un hydrops.<\/p><\/li><\/ul><\/li><li><p><strong>Pleurod\u00e8se intra-ut\u00e9rine<\/strong> :<\/p><ul><li><p>Intervention rare en raison du manque de recul sur son efficacit\u00e9 en m\u00e9decine f\u0153tale.<\/p><\/li><li><p>Peu d\u2019\u00e9tudes cliniques validant cette technique pour le traitement du chylothorax pr\u00e9natal.<\/p><\/li><\/ul><\/li><\/ol><p><strong>Pronostic et recommandations<\/strong> :<\/p><p>Le pronostic d\u00e9pend principalement de <strong>l\u2019\u00e9volution de l\u2019\u00e9panchement et de la pr\u00e9sence ou non d\u2019un hydrops<\/strong>. Une prise en charge pr\u00e9coce par shunt pleuro-amniotique est recommand\u00e9e dans les formes s\u00e9v\u00e8res pour \u00e9viter une <strong>hypoplasie pulmonaire<\/strong> et am\u00e9liorer l\u2019adaptation respiratoire n\u00e9onatale. L\u2019article conclut que <strong>la surveillance \u00e9chographique rapproch\u00e9e et la gestion multidisciplinaire sont essentielles pour optimiser la survie des nouveau-n\u00e9s atteints de chylothorax cong\u00e9nital<\/strong><\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1512\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-1512\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Prenatal diagnosis, imaging, and prognosis in Congenital Diaphragmatic Hernia Anne-Gael Cordier, Francesca M. Russo, Jan Deprest, Alexandra Benachi Seminars in Perinatology, 2020; 44(1): 51163<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1512\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-1512\"><p>La hernie diaphragmatique cong\u00e9nitale (HDC) est une malformation s\u00e9v\u00e8re associ\u00e9e \u00e0 une <strong>hypoplasie pulmonaire<\/strong> et une <strong>hypertension art\u00e9rielle pulmonaire<\/strong>. Cet article explore les <strong>avanc\u00e9es r\u00e9centes en imagerie pr\u00e9natale<\/strong>, les facteurs pronostiques et les perspectives th\u00e9rapeutiques in utero pour am\u00e9liorer les <strong>chances de survie n\u00e9onatale<\/strong>.<\/p><p><strong>1. D\u00e9pistage et imagerie pr\u00e9natale<\/strong><\/p><ul><li><p><strong>60 % des HDC sont d\u00e9tect\u00e9es par \u00e9chographie <\/strong><strong>d\u00e8s le 2\u1d49 trimestre<\/strong>.<\/p><\/li><li><p>Le diagnostic repose sur l\u2019identification d\u2019une <strong>d\u00e9viation cardiaque, d\u2019une position anormale de l\u2019estomac et\/ou d\u2019une hernie h\u00e9patique<\/strong>.<\/p><\/li><li><p>L\u2019<strong>IRM f\u0153tale<\/strong> est un compl\u00e9ment essentiel \u00e0 l\u2019\u00e9chographie pour <strong>quantifier le volume pulmonaire et \u00e9valuer la gravit\u00e9 de l\u2019atteinte<\/strong>.<\/p><\/li><li><p>Une \u00e9valuation g\u00e9n\u00e9tique est recommand\u00e9e, car <strong>40 % des cas sont associ\u00e9s \u00e0 des anomalies chromosomiques ou syndromiques<\/strong>.<\/p><\/li><\/ul><p><strong>2. Facteurs pronostiques et classification de la s\u00e9v\u00e9rit\u00e9<\/strong><\/p><ul><li><p><strong>Lung-to-Head Ratio (LHR)<\/strong> : indicateur cl\u00e9 du d\u00e9veloppement pulmonaire.<\/p><ul><li><p>LHR &lt; 25 % \u2192 mauvais pronostic.<\/p><\/li><li><p>LHR &gt; 45 % \u2192 meilleur taux de survie.<\/p><\/li><\/ul><\/li><li><p><strong>Position du foie<\/strong> : un <strong>foie intrathoracique<\/strong> est un facteur aggravant, r\u00e9duisant la probabilit\u00e9 de survie.<\/p><\/li><li><p><strong>Pr\u00e9sence d\u2019hypertension pulmonaire persistante (HPPN)<\/strong> : pr\u00e9diction encore limit\u00e9e malgr\u00e9 les progr\u00e8s en imagerie Doppler.<\/p><\/li><\/ul><p><strong>3. Approches th\u00e9rapeutiques pr\u00e9natales et gestion p\u00e9rinatale<\/strong><\/p><ul><li><p><strong>Occlusion trach\u00e9ale f\u0153toscopique (FETO)<\/strong> : intervention visant \u00e0 <strong>stimuler la croissance pulmonaire<\/strong> en bloquant l\u2019\u00e9vacuation du liquide pulmonaire.<\/p><\/li><li><p><strong>Classification des f\u0153tus candidats \u00e0 une intervention in utero<\/strong> bas\u00e9e sur les donn\u00e9es \u00e9chographiques et IRM.<\/p><\/li><li><p>Planification de l\u2019accouchement dans un <strong>centre tertiaire sp\u00e9cialis\u00e9<\/strong> pour maximiser les chances de survie postnatale.<\/p><\/li><\/ul><p><strong>4. Perspectives et axes de recherche<\/strong><\/p><ul><li><p>L\u2019am\u00e9lioration des algorithmes de <strong>pr\u00e9diction de la s\u00e9v\u00e9rit\u00e9<\/strong> reste une priorit\u00e9.<\/p><\/li><li><p>Des <strong>th\u00e9rapies alternatives<\/strong>, comme le <strong>sild\u00e9nafil<\/strong> ou les traitements ciblant l\u2019<strong>hypertension pulmonaire n\u00e9onatale<\/strong>, sont \u00e0 l\u2019\u00e9tude.<\/p><\/li><\/ul><p><strong>Conclusion<\/strong><\/p><p>Gr\u00e2ce aux avanc\u00e9es en imagerie et en th\u00e9rapie pr\u00e9natale, la prise en charge des f\u0153tus atteints de HDC a consid\u00e9rablement \u00e9volu\u00e9. L\u2019identification pr\u00e9coce des <strong>facteurs de risque<\/strong> et l\u2019optimisation des strat\u00e9gies th\u00e9rapeutiques permettent <strong>d\u2019am\u00e9liorer les perspectives de survie et de r\u00e9duire la morbidit\u00e9<\/strong> chez les nouveau-n\u00e9s.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1513\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-1513\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Guide pratique de l\u2019\u00e9chographie obst\u00e9tricale et gyn\u00e9cologique Grange G. (2021). ISBN: 978-2-294-77611-3.<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1513\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-1513\"><p>Ce chapitre est d\u00e9di\u00e9 \u00e0 l\u2019\u00e9valuation \u00e9chographique des <strong>pathologies thoraciques f\u0153tales<\/strong> et couvre des conditions comme :<\/p><ul><li><strong>Les maladies ad\u00e9nomato\u00efdes kystiques pulmonaires (MAKP)<\/strong><\/li><li><strong>La s\u00e9questration pulmonaire<\/strong><\/li><li><strong>Les kystes bronchog\u00e9niques<\/strong><\/li><li><strong>Les atr\u00e9sies bronchiques<\/strong><\/li><li><strong>L\u2019hernie diaphragmatique<\/strong><\/li><\/ul><p>L\u2019auteur d\u00e9crit les <strong>crit\u00e8res \u00e9chographiques essentiels<\/strong> permettant de <strong>diff\u00e9rencier ces pathologies<\/strong> et insiste sur la n\u00e9cessit\u00e9 d\u2019un <strong>suivi \u00e9chographique rapproch\u00e9<\/strong>, notamment entre <strong>28 et 30 SA<\/strong>, p\u00e9riode o\u00f9 les l\u00e9sions peuvent \u00e9voluer. Un <strong>tableau r\u00e9capitulatif des anomalies thoraciques<\/strong> est inclus, avec leur impact sur la croissance pulmonaire et les effets de compression m\u00e9diastinale.<\/p><p>L\u2019importance du <strong>Doppler couleur<\/strong> et de l\u2019IRM pour les cas complexes est \u00e9galement soulign\u00e9e. L\u2019ouvrage recommande une approche multidisciplinaire pour la prise en charge des grossesses compliqu\u00e9es par des malformations thoraciques.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1514\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-1514\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Syndrome de Pallister-Killian : confrontation des donn\u00e9es pr\u00e9natales et foetopathologiques de six cas et revue de la litterature D. Desseauve et al. \/ Gyn\u00e9cologie Obst\u00e9trique & Fertilit\u00e9 44 (2016) 200\u2013206<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1514\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-1514\"><p>Le <strong>syndrome de Pallister-Killian (SPK)<\/strong> est une anomalie chromosomique rare due \u00e0 une <strong>t\u00e9trasomie 12p en mosa\u00efque<\/strong>, souvent associ\u00e9e \u00e0 un <strong>ph\u00e9notype polymalformatif<\/strong>. Son diagnostic pr\u00e9natal est complexe, car les signes \u00e9chographiques sont vari\u00e9s et parfois peu sp\u00e9cifiques. Cette \u00e9tude multicentrique r\u00e9trospective vise \u00e0 comparer les <strong>donn\u00e9es \u00e9chographiques pr\u00e9natales et f\u0153topathologiques<\/strong> de six cas confirm\u00e9s par analyse cytog\u00e9n\u00e9tique.<\/p><p><strong>M\u00e9thodes<\/strong><\/p><ul><li><p>Recueil des cas par un appel \u00e0 collaboration aupr\u00e8s des membres de la <strong>Soci\u00e9t\u00e9 de F\u0153topathologie Fran\u00e7aise (SOFFOET)<\/strong>.<\/p><\/li><li><p>Analyse des <strong>donn\u00e9es \u00e9chographiques pr\u00e9natales<\/strong>, compl\u00e9t\u00e9e par une <strong>autopsie f\u0153tale<\/strong> apr\u00e8s interruption m\u00e9dicale de grossesse.<\/p><\/li><li><p>Revue de la litt\u00e9rature pour comparer les anomalies morphologiques d\u00e9crites dans le SPK.<\/p><\/li><\/ul><p><strong>R\u00e9sultats<\/strong><\/p><ul><li><p><strong>Hernie diaphragmatique<\/strong> pr\u00e9sente dans <strong>un seul des six cas<\/strong>, bien que souvent associ\u00e9e au SPK.<\/p><\/li><li><p><strong>Dysmorphie cranio-faciale (5 cas\/6)<\/strong> : hyperplasie frontale, philtrum long, hypert\u00e9lorisme.<\/p><\/li><li><p><strong>Microm\u00e9lie et anomalies des membres (3 cas\/6)<\/strong> : f\u00e9mur court, brachydactylie.<\/p><\/li><li><p><strong>Absence de retard de croissance intra-ut\u00e9rin<\/strong>, avec m\u00eame une <strong>tendance \u00e0 la macrosomie<\/strong> (+2,67 DS selon certaines \u00e9tudes).<\/p><\/li><li><p><strong>\u00c9panchement pleural et malformations cardiaques<\/strong> d\u00e9tect\u00e9s dans certains cas.<\/p><\/li><\/ul><p><strong>Discussion et perspectives<\/strong><\/p><p>L\u2019\u00e9tude confirme que <strong>l\u2019\u00e9chographie pr\u00e9natale ne permet pas toujours un diagnostic d\u00e9finitif du SPK<\/strong>. L\u2019absence syst\u00e9matique de <strong>hernie diaphragmatique<\/strong> dans cette s\u00e9rie remet en question la perception de cette anomalie comme un marqueur constant du SPK. Les auteurs soulignent l\u2019importance d\u2019<strong>associer l\u2019\u00e9chographie 3D et le caryotype mol\u00e9culaire (CGH array)<\/strong> pour affiner le diagnostic.<\/p><p><strong>Conclusion<\/strong><\/p><p>Certaines associations malformatives (dysmorphie faciale, microm\u00e9lie, absence de retard de croissance) doivent \u00e9veiller la suspicion d\u2019un SPK m\u00eame <strong>en l\u2019absence de hernie diaphragmatique<\/strong>. L\u2019article recommande un <strong>recours syst\u00e9matique au caryotype mol\u00e9culaire<\/strong> pour poser un diagnostic fiable et \u00e9viter les <strong>faux n\u00e9gatifs li\u00e9s au mosa\u00efcisme faible<\/strong><\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1515\" class=\"elementor-tab-title\" data-tab=\"5\" role=\"button\" aria-controls=\"elementor-tab-content-1515\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Prenatal diagnosis and management of congenital diaphragmatic hernia  D. Basurto et al. Best Practice & Research Clinical Obstetrics and Gynaecology 58 (2019) 93e106<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1515\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"5\" role=\"region\" aria-labelledby=\"elementor-tab-title-1515\"><p>Cet article passe en revue les avanc\u00e9es r\u00e9centes dans le <strong>diagnostic pr\u00e9natal, l&#8217;imagerie et la gestion de la hernie diaphragmatique cong\u00e9nitale (HDC)<\/strong>, une anomalie caract\u00e9ris\u00e9e par un d\u00e9faut de fermeture du diaphragme, entra\u00eenant la migration des organes abdominaux dans la cavit\u00e9 thoracique et perturbant le d\u00e9veloppement pulmonaire.<\/p><p><strong>1. Diagnostic pr\u00e9natal et imagerie<\/strong><\/p><ul><li><p>L\u2019HDC est <strong>d\u00e9tect\u00e9e chez 60 \u00e0 70 % des f\u0153tus lors du d\u00e9pistage \u00e9chographique du 2\u1d49 trimestre<\/strong>.<\/p><\/li><li><p>L&#8217;\u00e9chographie montre <strong>une d\u00e9viation cardiaque, une hernie du foie et un volume pulmonaire r\u00e9duit<\/strong>.<\/p><\/li><li><p>L\u2019<strong>IRM pr\u00e9natale<\/strong> est utilis\u00e9e pour affiner l\u2019\u00e9valuation du volume pulmonaire total et de la position du foie.<\/p><\/li><li><p>Des tests g\u00e9n\u00e9tiques avanc\u00e9s permettent d\u2019identifier des cas syndromiques d\u2019HDC, repr\u00e9sentant <strong>jusqu&#8217;\u00e0 40 % des diagnostics<\/strong>.<\/p><\/li><\/ul><p><strong>2. Facteurs pronostiques et classification de la s\u00e9v\u00e9rit\u00e9<\/strong><\/p><ul><li><p>L\u2019estimation du <strong>Lung-to-Head Ratio (LHR)<\/strong> permet de pr\u00e9dire le risque d\u2019hypoplasie pulmonaire :<\/p><ul><li><p><strong>LHR &gt; 45 %<\/strong> : bon pronostic<\/p><\/li><li><p><strong>LHR &lt; 25 %<\/strong> : risque de complications s\u00e9v\u00e8res<\/p><\/li><\/ul><\/li><li><p>La <strong>position du foie<\/strong> et de l\u2019<strong>estomac<\/strong> sont \u00e9galement des marqueurs de s\u00e9v\u00e9rit\u00e9, bien que leur valeur pr\u00e9dictive soit encore d\u00e9battue.<\/p><\/li><li><p>L\u2019<strong>hypertension pulmonaire persistante (HPPN)<\/strong> demeure le principal facteur influen\u00e7ant la survie n\u00e9onatale, mais sa pr\u00e9diction en pr\u00e9natal reste un d\u00e9fi.<\/p><\/li><\/ul><p><strong>3. Approches th\u00e9rapeutiques pr\u00e9natales<\/strong><\/p><ul><li><p>L\u2019<strong>occlusion trach\u00e9ale f\u0153toscopique (FETO)<\/strong> est une proc\u00e9dure exp\u00e9rimentale qui vise \u00e0 stimuler la croissance pulmonaire en bloquant l\u2019\u00e9vacuation du liquide pulmonaire.<\/p><\/li><li><p>Le FETO est actuellement \u00e9valu\u00e9 dans le cadre de l\u2019<strong>essai clinique TOTAL<\/strong>, une \u00e9tude randomis\u00e9e internationale.<\/p><\/li><li><p>D&#8217;autres approches en cours d\u2019\u00e9valuation incluent l\u2019administration maternelle de <strong>sild\u00e9nafil<\/strong>, un vasodilatateur visant \u00e0 r\u00e9duire l\u2019<strong>hypertension pulmonaire n\u00e9onatale<\/strong>.<\/p><\/li><\/ul><p><strong>4. Gestion p\u00e9rinatale et postnatale<\/strong><\/p><ul><li><p>L\u2019accouchement doit \u00eatre planifi\u00e9 dans un <strong>centre tertiaire sp\u00e9cialis\u00e9<\/strong>, avec une prise en charge n\u00e9onatale standardis\u00e9e.<\/p><\/li><li><p>Les survivants n\u00e9cessitent un <strong>suivi \u00e0 long terme<\/strong>, car des complications telles que le <strong>reflux gastro-\u0153sophagien, des troubles de l\u2019alimentation et un retard de croissance<\/strong> sont fr\u00e9quents.<\/p><\/li><\/ul><p><strong>Conclusion<\/strong><\/p><p>L\u2019am\u00e9lioration du <strong>diagnostic pr\u00e9natal et des techniques d\u2019imagerie<\/strong> a permis une meilleure individualisation du pronostic des f\u0153tus atteints d\u2019HDC. Bien que des avanc\u00e9es majeures aient \u00e9t\u00e9 faites avec des strat\u00e9gies comme le <strong>FETO<\/strong>, des recherches sont encore n\u00e9cessaires pour am\u00e9liorer la pr\u00e9diction de l\u2019<strong>hypertension pulmonaire n\u00e9onatale<\/strong> et d\u00e9velopper de nouvelles options th\u00e9rapeutiques<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1516\" class=\"elementor-tab-title\" data-tab=\"6\" role=\"button\" aria-controls=\"elementor-tab-content-1516\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Comment je fais. . . l\u2019\u00e9chographie d\u2019un foetus porteur d\u2019une hernie de coupole diaphragmatique ? H. Bouchghoul et al. Gyn\u00e9cologie Obst\u00e9trique Fertilit\u00e9 & S\u00e9nologie 49 (2021) 143\u2013146<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1516\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"6\" role=\"region\" aria-labelledby=\"elementor-tab-title-1516\"><p>Cet article fournit une approche m\u00e9thodique pour la <strong>r\u00e9alisation de l\u2019\u00e9chographie diagnostique d\u2019une hernie diaphragmatique cong\u00e9nitale (HDC)<\/strong>. L\u2019HDC est une <strong>anomalie cong\u00e9nitale s\u00e9v\u00e8re<\/strong>, caract\u00e9ris\u00e9e par le passage d\u2019organes abdominaux dans la cavit\u00e9 thoracique, induisant une <strong>hypoplasie pulmonaire et une hypertension art\u00e9rielle pulmonaire<\/strong>. L\u2019article d\u00e9taille les <strong>signes \u00e9chographiques essentiels, les outils de pronostic et les recommandations de prise en charge<\/strong>.<\/p><p><strong>1. Diagnostic \u00e9chographique et signes d\u2019alerte<\/strong><\/p><ul><li><p><strong>Visualisation inhabituelle de l\u2019estomac dans le thorax<\/strong>, particuli\u00e8rement en cas de <strong>HDC gauche<\/strong>.<\/p><\/li><li><p><strong>D\u00e9viation du c\u0153ur vers le c\u00f4t\u00e9 oppos\u00e9<\/strong> avec compression des cavit\u00e9s cardiaques.<\/p><\/li><li><p><strong>Pr\u00e9sence du foie dans le thorax<\/strong>, particuli\u00e8rement dans les hernies droites, rendant leur diagnostic plus difficile.<\/p><\/li><li><p><strong>Absence ou image anormale de la coupole diaphragmatique<\/strong> en coupe parasagittale.<\/p><\/li><\/ul><p><strong>2. \u00c9valuation des malformations associ\u00e9es<\/strong><\/p><ul><li><p>La HDC est associ\u00e9e \u00e0 <strong>des anomalies g\u00e9n\u00e9tiques et morphologiques dans 35 % des cas<\/strong>.<\/p><\/li><li><p>Une <strong>\u00e9chocardiographie f\u0153tale<\/strong> est indispensable en raison du risque \u00e9lev\u00e9 de malformations cardiaques (d\u00e9fauts septaux, anomalies conotroncales).<\/p><\/li><li><p><strong>Amniocent\u00e8se et analyse chromosomique recommand\u00e9es<\/strong>, notamment pour exclure la <strong>trisomie 18 et le syndrome de Pallister-Killian<\/strong>.<\/p><\/li><\/ul><p><strong>3. Facteurs pronostiques et outils d\u2019\u00e9valuation<\/strong><\/p><ul><li><p><strong>Lung-to-Head Ratio (LHR)<\/strong> : estimation du degr\u00e9 d\u2019hypoplasie pulmonaire. Un LHR inf\u00e9rieur \u00e0 <strong>0,6<\/strong> est associ\u00e9 \u00e0 un tr\u00e8s mauvais pronostic.<\/p><\/li><li><p><strong>Position du foie<\/strong> : un foie intrathoracique est un facteur de s\u00e9v\u00e9rit\u00e9.<\/p><\/li><li><p><strong>IRM f\u0153tale<\/strong> : utilis\u00e9e pour \u00e9valuer le volume pulmonaire total et am\u00e9liorer la pr\u00e9diction de la survie n\u00e9onatale.<\/p><\/li><\/ul><p><strong>4. Options th\u00e9rapeutiques pr\u00e9natales et prise en charge p\u00e9rinatale<\/strong><\/p><ul><li><p><strong>Th\u00e9rapie f\u0153tale par occlusion trach\u00e9ale intra-ut\u00e9rine (FETO)<\/strong>, r\u00e9alis\u00e9e entre <strong>28 et 30 SA<\/strong>, pour stimuler la croissance pulmonaire en cas de pronostic d\u00e9favorable.<\/p><\/li><li><p><strong>Accouchement en centre de r\u00e9f\u00e9rence (niveau III)<\/strong> avec service de r\u00e9animation et chirurgie n\u00e9onatale.<\/p><\/li><\/ul><p><strong>Conclusion<\/strong><\/p><p>L\u2019\u00e9chographie est un outil central pour le <strong>diagnostic et l\u2019\u00e9valuation pronostique de la HDC<\/strong>. L\u2019article met en avant la n\u00e9cessit\u00e9 d\u2019un protocole standardis\u00e9 pour \u00e9valuer <strong>la s\u00e9v\u00e9rit\u00e9 de l\u2019atteinte pulmonaire et les malformations associ\u00e9es<\/strong> afin d\u2019optimiser la prise en charge p\u00e9rinatale et am\u00e9liorer les chances de survie n\u00e9onatale<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"has_eae_slider elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-dfff2c2\" data-id=\"dfff2c2\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a82745c elementor-widget elementor-widget-toggle\" data-id=\"a82745c\" data-element_type=\"widget\" data-widget_type=\"toggle.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle\">\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1761\" class=\"elementor-tab-title\" data-tab=\"1\" role=\"button\" aria-controls=\"elementor-tab-content-1761\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Fetal mediastinal teratoma: Misinterpretation as congenital cystic lesions of the lung on prenatal ultrasound  Sihem Darouich, Houda Bellamine  Clin Ultrasound. 2020;48:287\u2013290<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1761\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"1\" role=\"region\" aria-labelledby=\"elementor-tab-title-1761\"><p>Le t\u00e9ratome m\u00e9diastinal f\u0153tal est une <strong>tumeur rare mais potentiellement mortelle<\/strong>, pouvant \u00eatre confondue avec d\u2019autres l\u00e9sions kystiques pulmonaires cong\u00e9nitales en \u00e9chographie pr\u00e9natale. Cette \u00e9tude de cas d\u00e9crit un <strong>t\u00e9ratome m\u00e9diastinal immature associ\u00e9 \u00e0 un hydrops f\u0153tal s\u00e9v\u00e8re<\/strong>, initialement mal diagnostiqu\u00e9 comme une <strong>malformation kystique ad\u00e9nomato\u00efde pulmonaire (CCAM)<\/strong> en raison de sa structure mixte.<\/p><ol><li><strong> Pr\u00e9sentation du cas et diagnostic pr\u00e9natal<\/strong><\/li><\/ol><ul><li>Une <strong>patiente de 31 ans (G2P2)<\/strong> est r\u00e9f\u00e9r\u00e9e pour \u00e9valuation d\u2019un <strong>hydrops f\u0153tal s\u00e9v\u00e8re<\/strong> \u00e0 <strong>23 semaines de gestation<\/strong>.<\/li><li>L\u2019\u00e9chographie met en \u00e9vidence :<ul><li>Une <strong>masse mixte kystique et solide dans le m\u00e9diastin<\/strong>.<\/li><li>Une <strong>d\u00e9viation cardiaque vers le c\u00f4t\u00e9 gauche<\/strong>, mimant une CCAM.<\/li><li>Des <strong>effusions pleurales et ascites massives<\/strong>, signes \u00e9vocateurs d\u2019un hydrops.<\/li><\/ul><\/li><li>L\u2019<strong>IRM f\u0153tale n\u2019a pas \u00e9t\u00e9 r\u00e9alis\u00e9e<\/strong>, et le diagnostic initial est rest\u00e9 incertain.<\/li><\/ul><ol start=\"2\"><li><strong> Cons\u00e9quences f\u0153tales et d\u00e9cision obst\u00e9tricale<\/strong><\/li><\/ol><ul><li>L\u2019\u00e9volution rapide de l\u2019hydrops a conduit \u00e0 une <strong>interruption m\u00e9dicale de grossesse \u00e0 24 semaines<\/strong>, apr\u00e8s consentement parental.<\/li><li>L\u2019autopsie r\u00e9v\u00e8le :<ul><li>Une <strong>masse bien encapsul\u00e9e de 6,1 \u00d7 4,4 \u00d7 2,8 cm<\/strong> comprimant s\u00e9v\u00e8rement le c\u0153ur et les poumons.<\/li><li>Une <strong>hypoplasie pulmonaire et thymique majeure<\/strong>.<\/li><li>Une <strong>h\u00e9morragie intraventriculaire c\u00e9r\u00e9brale<\/strong>, cons\u00e9quence d\u2019une insuffisance cardiaque f\u0153tale.<\/li><\/ul><\/li><\/ul><ol start=\"3\"><li><strong> Discussion et implications diagnostiques<\/strong><\/li><\/ol><ul><li><strong>Le t\u00e9ratome m\u00e9diastinal f\u0153tal peut \u00eatre mal interpr\u00e9t\u00e9<\/strong> comme une <strong>malformation pulmonaire kystique<\/strong> ou une <strong>hernie diaphragmatique<\/strong> en \u00e9chographie pr\u00e9natale.<\/li><li><strong>L\u2019\u00e9valuation Doppler<\/strong> aurait permis d\u2019am\u00e9liorer la d\u00e9tection en analysant l\u2019irrigation vasculaire de la masse.<\/li><li>La <strong>compression cardiaque et vasculaire<\/strong> par la tumeur entra\u00eene une <strong>insuffisance cardiaque et un hydrops<\/strong>, principaux facteurs de mauvais pronostic.<\/li><li>En cas de diagnostic pr\u00e9natal pr\u00e9coce, des <strong>interventions f\u0153tales exp\u00e9rimentales<\/strong> (drainage de la tumeur, r\u00e9section intra-ut\u00e9rine) pourraient \u00eatre envisag\u00e9es.<\/li><\/ul><p><strong>Conclusion<\/strong><\/p><p>Le t\u00e9ratome m\u00e9diastinal f\u0153tal est une pathologie <strong>rare et difficile \u00e0 diagnostiquer en pr\u00e9natal<\/strong>. Cet article met en \u00e9vidence l&#8217;importance d\u2019un <strong>diagnostic diff\u00e9rentiel pr\u00e9cis<\/strong> via une <strong>\u00e9chographie de haute r\u00e9solution et une \u00e9valuation Doppler<\/strong>, pour \u00e9viter les erreurs d\u2019interpr\u00e9tation et mieux anticiper la prise en charge postnatale.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1762\" class=\"elementor-tab-title\" data-tab=\"2\" role=\"button\" aria-controls=\"elementor-tab-content-1762\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Neonatal Outcomes of Prenatally Diagnosed Congenital Pulmonary Malformations I. Ruchonnet-Metrailler et al., Pediatrics, 2014; 133: e1285\u2013e1291<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1762\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"2\" role=\"region\" aria-labelledby=\"elementor-tab-title-1762\"><p>Les <strong>malformations pulmonaires cong\u00e9nitales (MPC)<\/strong> sont g\u00e9n\u00e9ralement d\u00e9tect\u00e9es lors des \u00e9chographies pr\u00e9natales. Si la plupart des nouveau-n\u00e9s atteints sont asymptomatiques \u00e0 la naissance, certains d\u00e9veloppent une <strong>d\u00e9tresse respiratoire s\u00e9v\u00e8re<\/strong>, n\u00e9cessitant une prise en charge imm\u00e9diate, incluant l\u2019<strong>assistance ventilatoire et la chirurgie n\u00e9onatale<\/strong>. Cependant, les <strong>facteurs pr\u00e9dictifs de d\u00e9tresse respiratoire n\u00e9onatale<\/strong> restent mal d\u00e9finis. Cette \u00e9tude vise \u00e0 identifier les <strong>marqueurs \u00e9chographiques pr\u00e9nataux<\/strong> pouvant pr\u00e9dire ces complications respiratoires postnatales.<\/p><p><strong>M\u00e9thodes<\/strong><\/p><ul><li><p>\u00c9tude bas\u00e9e sur le <strong>registre multicentrique RespiRare<\/strong>, collectant des donn\u00e9es sur les enfants n\u00e9s avec des pathologies respiratoires rares en France (2008-2013).<\/p><\/li><li><p>S\u00e9lection des cas avec un <strong>diagnostic pr\u00e9natal de l\u00e9sions pulmonaires hyperechog\u00e8nes et\/ou kystiques<\/strong>.<\/p><\/li><li><p>Analyse de la <strong>corr\u00e9lation entre les param\u00e8tres \u00e9chographiques pr\u00e9nataux et les sympt\u00f4mes respiratoires n\u00e9onataux<\/strong>.<\/p><\/li><\/ul><p><strong>R\u00e9sultats<\/strong><\/p><ul><li><p><strong>89 enfants inclus<\/strong>, parmi lesquels <strong>22 (25 %)<\/strong> ont pr\u00e9sent\u00e9 des <strong>difficult\u00e9s respiratoires \u00e0 la naissance<\/strong>.<\/p><\/li><li><p><strong>12 nouveau-n\u00e9s (13 %)<\/strong> ont souffert d\u2019une <strong>d\u00e9tresse respiratoire s\u00e9v\u00e8re<\/strong>, n\u00e9cessitant oxyg\u00e9noth\u00e9rapie et ventilation assist\u00e9e.<\/p><\/li><li><p>Plusieurs param\u00e8tres pr\u00e9nataux ont \u00e9t\u00e9 significativement associ\u00e9s au risque de d\u00e9tresse respiratoire :<\/p><ul><li><p><strong>D\u00e9placement m\u00e9diastinal (p = 0,0003)<\/strong><\/p><\/li><li><p><strong>Hydramnios (p = 0,05)<\/strong><\/p><\/li><li><p><strong>Ascite f\u0153tale (p = 0,0005)<\/strong><\/p><\/li><li><p><strong>Surface maximale de la malformation pr\u00e9natale (p = 0,001)<\/strong><\/p><\/li><li><p><strong>Rapport volume-malformation pulmonaire\/volume f\u0153tal (CVR) &gt; 0,84 (p = 0,001)<\/strong><\/p><\/li><\/ul><\/li><\/ul><p><strong>Conclusions<\/strong><\/p><p>Les r\u00e9sultats de cette \u00e9tude montrent que la <strong>pr\u00e9sence d\u2019un hydramnios, d\u2019une ascite et d\u2019un CVR &gt; 0,84<\/strong> sont des <strong>facteurs de risque majeurs de complications respiratoires \u00e0 la naissance<\/strong>. Les nouveau-n\u00e9s atteints doivent \u00eatre pris en charge dans <strong>un centre de soins intensifs n\u00e9onatals<\/strong> afin d\u2019optimiser leur prise en charge imm\u00e9diate et r\u00e9duire la morbidit\u00e9 associ\u00e9e.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1763\" class=\"elementor-tab-title\" data-tab=\"3\" role=\"button\" aria-controls=\"elementor-tab-content-1763\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Ultrasound detected prenatal hyperechoic lung lesions and concordance with postnatal findings: A common aspect for multiple diagnoses Michela Cing Yu Wong et al., Prenatal Diagnosis, 2021; 41(3): 323-331<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1763\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"3\" role=\"region\" aria-labelledby=\"elementor-tab-title-1763\"><p>Les l\u00e9sions pulmonaires hyperechog\u00e8nes f\u0153tales sont fr\u00e9quemment d\u00e9tect\u00e9es en \u00e9chographie pr\u00e9natale, mais leur <strong>\u00e9tiologie exacte et leur signification clinique restent mal d\u00e9finies<\/strong>. Cette \u00e9tude vise \u00e0 \u00e9valuer la <strong>corr\u00e9lation entre les diagnostics pr\u00e9nataux et postnataux<\/strong> afin d&#8217;am\u00e9liorer la prise en charge p\u00e9rinatale et le conseil aux parents.<\/p><p><strong>1. M\u00e9thodes<\/strong><\/p><ul><li><p>\u00c9tude r\u00e9trospective portant sur <strong>75 cas diagnostiqu\u00e9s entre 2009 et 2018<\/strong>.<\/p><\/li><li><p>L\u2019\u00e9valuation pr\u00e9natale a \u00e9t\u00e9 r\u00e9alis\u00e9e par \u00e9chographie f\u0153tale et Doppler couleur.<\/p><\/li><li><p>L\u2019analyse postnatale repose sur la <strong>tomodensitom\u00e9trie (CT-scan)<\/strong> et, dans certains cas, l\u2019examen histologique apr\u00e8s r\u00e9section chirurgicale.<\/p><\/li><\/ul><p><strong>2. R\u00e9sultats principaux<\/strong><\/p><ul><li><p><strong>Trois diagnostics pr\u00e9nataux les plus fr\u00e9quents<\/strong> :<\/p><ul><li><p><strong>S\u00e9questration bronchopulmonaire (BPS)<\/strong> : 24 cas (32 %)<\/p><\/li><li><p><strong>Malformations pulmonaires kystiques cong\u00e9nitales (PCM)<\/strong> : 19 cas (25 %)<\/p><\/li><li><p><strong>Emphys\u00e8me lobaire cong\u00e9nital (CLE)<\/strong> : 15 cas (20 %)<\/p><\/li><\/ul><\/li><li><p>Une <strong>d\u00e9viation m\u00e9diastinale<\/strong> \u00e9tait pr\u00e9sente chez 18 f\u0153tus (24 %).<\/p><\/li><li><p><strong>Taux de concordance diagnostique pr\u00e9natal-postnatal<\/strong> :<\/p><ul><li><p>D\u00e9tection de l\u2019<strong>art\u00e8re syst\u00e9mique d\u2019alimentation<\/strong> (caract\u00e9ristique du BPS) : <strong>90 % de pr\u00e9cision<\/strong>.<\/p><\/li><li><p>D\u00e9tection d\u2019une <strong>composante kystique<\/strong> : <strong>76,5 % de pr\u00e9cision<\/strong>.<\/p><\/li><\/ul><\/li><li><p><strong>16 nouveau-n\u00e9s<\/strong> avec une <strong>simple d\u00e9viation m\u00e9diastinale isol\u00e9e<\/strong> \u00e9taient asymptomatiques \u00e0 la naissance.<\/p><\/li><li><p><strong>7 nouveau-n\u00e9s<\/strong> ont d\u00e9velopp\u00e9 une <strong>d\u00e9tresse respiratoire<\/strong> non anticip\u00e9e lors du diagnostic pr\u00e9natal.<\/p><\/li><\/ul><p><strong>3. Discussion et implications cliniques<\/strong><\/p><ul><li><p>Les <strong>l\u00e9sions pulmonaires hyperechog\u00e8nes<\/strong> sont une <strong>entit\u00e9 h\u00e9t\u00e9rog\u00e8ne<\/strong> et peuvent correspondre \u00e0 plusieurs malformations pulmonaires cong\u00e9nitales.<\/p><\/li><li><p>Si la d\u00e9tection d\u2019une <strong>art\u00e8re syst\u00e9mique<\/strong> permet de confirmer un BPS avec une <strong>forte fiabilit\u00e9<\/strong>, la <strong>pr\u00e9diction des l\u00e9sions kystiques reste plus impr\u00e9cise<\/strong>.<\/p><\/li><li><p>L\u2019<strong>\u00e9volution des l\u00e9sions apr\u00e8s la naissance est variable<\/strong>, et certaines anomalies consid\u00e9r\u00e9es comme graves en pr\u00e9natal se r\u00e9v\u00e8lent b\u00e9nignes postnatales.<\/p><\/li><\/ul><p><strong>4. Conclusion<\/strong><\/p><p>L\u2019\u00e9tude met en \u00e9vidence que, malgr\u00e9 les progr\u00e8s de l\u2019imagerie pr\u00e9natale, la <strong>pr\u00e9diction pr\u00e9cise des l\u00e9sions pulmonaires f\u0153tales reste un d\u00e9fi<\/strong>. Si certaines anomalies, comme le BPS, peuvent \u00eatre bien identifi\u00e9es, d&#8217;autres restent difficiles \u00e0 classifier avant la naissance. Une \u00e9valuation rigoureuse et un suivi postnatal syst\u00e9matique restent donc essentiels pour optimiser la <strong>prise en charge des nouveau-n\u00e9s<\/strong> atteints.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-toggle-item\">\n\t\t\t\t\t<div id=\"elementor-tab-title-1764\" class=\"elementor-tab-title\" data-tab=\"4\" role=\"button\" aria-controls=\"elementor-tab-content-1764\" aria-expanded=\"false\">\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon elementor-toggle-icon-left\" aria-hidden=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-closed\"><i class=\"fas fa-caret-right\"><\/i><\/span>\n\t\t\t\t\t\t\t\t<span class=\"elementor-toggle-icon-opened\"><i class=\"elementor-toggle-icon-opened fas fa-caret-up\"><\/i><\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t<a class=\"elementor-toggle-title\" tabindex=\"0\">Prenatal natural history of congenital pulmonary malformations: MALFPULM population-based cohort study C. Delacourt et al., Ultrasound in Obstetrics & Gynecology, 2019; 54: 381-388<\/a>\n\t\t\t\t\t<\/div>\n\n\t\t\t\t\t<div id=\"elementor-tab-content-1764\" class=\"elementor-tab-content elementor-clearfix\" data-tab=\"4\" role=\"region\" aria-labelledby=\"elementor-tab-title-1764\"><p>Les <strong>malformations pulmonaires cong\u00e9nitales (MPC)<\/strong> sont des anomalies d\u00e9tect\u00e9es en pr\u00e9natal par \u00e9chographie, souvent sous la forme de l\u00e9sions <strong>hyperechog\u00e8nes ou kystiques<\/strong>. Cependant, l\u2019\u00e9volution naturelle de ces l\u00e9sions et leur impact sur le pronostic f\u0153tal restent mal compris. L\u2019objectif de cette \u00e9tude est d\u2019analyser les <strong>modifications du volume des MPC pendant la grossesse<\/strong> et d\u2019examiner leur corr\u00e9lation avec les risques de <strong>compression f\u0153tale<\/strong>.<\/p><p><strong>1. M\u00e9thodes<\/strong><\/p><ul><li><p>\u00c9tude <strong>prospective multicentrique<\/strong> bas\u00e9e sur la cohorte fran\u00e7aise <strong>MALFPULM<\/strong>, recrutant <strong>176 femmes enceintes<\/strong> entre 2015 et 2016.<\/p><\/li><li><p>Suivi \u00e9chographique rigoureux avec <strong>579 \u00e9chographies analys\u00e9es<\/strong> entre le diagnostic et l\u2019accouchement.<\/p><\/li><li><p>Analyse de la corr\u00e9lation entre le <strong>volume des malformations pulmonaires<\/strong> et l\u2019apparition de <strong>signes de compression<\/strong> (d\u00e9placement m\u00e9diastinal, hydrops, ascite, polyhydramnios).<\/p><\/li><\/ul><p><strong>2. R\u00e9sultats principaux<\/strong><\/p><ul><li><p>Une <strong>diminution significative<\/strong> du <strong>ratio de volume des MPC (CVR)<\/strong> avec l\u2019\u00e2ge gestationnel (p &lt; 0,001).<\/p><\/li><li><p><strong>Diff\u00e9rences selon le ph\u00e9notype \u00e9chographique<\/strong> :<\/p><ul><li><p>Les l\u00e9sions <strong>kystiques\/mix\u00e9es<\/strong> pr\u00e9sentent une <strong>r\u00e9duction progressive et lin\u00e9aire du CVR<\/strong>.<\/p><\/li><li><p>Les l\u00e9sions <strong>hyperechog\u00e8nes<\/strong> montrent d\u2019abord une <strong>augmentation du CVR jusqu\u2019\u00e0 27 SA<\/strong>, suivie d\u2019une diminution marqu\u00e9e.<\/p><\/li><\/ul><\/li><li><p>Le <strong>CVR initial \u00e9lev\u00e9 (&gt;0,4 cm\u00b2)<\/strong> est un facteur de risque de <strong>compression f\u0153tale<\/strong>.<\/p><\/li><li><p><strong>45 % des f\u0153tus<\/strong> pr\u00e9sentaient un <strong>d\u00e9placement m\u00e9diastinal<\/strong>, et <strong>1,7 %<\/strong> ont d\u00e9velopp\u00e9 un <strong>hydrops s\u00e9v\u00e8re<\/strong>.<\/p><\/li><\/ul><p><strong>3. Discussion et implications cliniques<\/strong><\/p><ul><li><p>L\u2019\u00e9volution du volume des MPC est <strong>ph\u00e9notype-d\u00e9pendante<\/strong>, ce qui peut influencer la strat\u00e9gie de surveillance et de traitement.<\/p><\/li><li><p>Un <strong>CVR \u00e9lev\u00e9<\/strong> d\u00e8s le premier diagnostic \u00e9chographique augmente le risque de complications intra-ut\u00e9rines, n\u00e9cessitant une <strong>surveillance rapproch\u00e9e<\/strong>.<\/p><\/li><li><p>Ces r\u00e9sultats sugg\u00e8rent que le <strong>CVR mesur\u00e9 pr\u00e9cocement peut aider \u00e0 pr\u00e9dire les risques f\u0153taux<\/strong> et optimiser la prise en charge p\u00e9rinatale.<\/p><\/li><\/ul><p><strong>4. Conclusion<\/strong><\/p><p>Cette \u00e9tude met en \u00e9vidence des <strong>diff\u00e9rences importantes entre les malformations kystiques et hyperechog\u00e8nes<\/strong> en termes de croissance et de r\u00e9solution spontan\u00e9e. L\u2019utilisation du <strong>CVR comme biomarqueur pronostique<\/strong> pourrait permettre d\u2019am\u00e9liorer la <strong>stratification du risque et les recommandations pour la prise en charge des MPC<\/strong>.<\/p><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>\u00c9chographie du thorax f\u0153tal : De l&#8217;anatomie normale aux malformations complexes Demo Demo Dr Pierre Dupont Hm-envelop Linkedin X-twitter Dr Margaret Smith Hm-envelop Linkedin Dr Fran\u00e7ois durand Hm-envelop Youtube Linkedin Ce cours, d\u2019une dur\u00e9e de deux heures, vise \u00e0 fournir aux participants une approche compl\u00e8te et structur\u00e9e de l\u2019\u00e9chographie du thorax f\u0153tal, allant de l\u2019anatomie normale aux malformations les plus complexes. Dans un premier temps, nous aborderons les bases de l\u2019\u00e9chographie thoracique, en d\u00e9taillant les techniques d\u2019imagerie utilis\u00e9es, les coupes \u00e9chographiques essentielles et les crit\u00e8res d\u2019\u00e9valuation des structures thoraciques normales. Cette compr\u00e9hension de l\u2019anatomie normale est indispensable pour identifier toute anomalie et en \u00e9valuer la s\u00e9v\u00e9rit\u00e9. Nous explorerons ensuite les principales malformations cong\u00e9nitales, notamment la hernie diaphragmatique cong\u00e9nitale (HDC) et les malformations pulmonaires cong\u00e9nitales telles que la maladie ad\u00e9nomato\u00efde kystique pulmonaire (MAKP) et la s\u00e9questration pulmonaire. L\u2019accent sera mis sur les signes \u00e9chographiques distinctifs, les outils pronostiques comme le Lung-to-Head Ratio (LHR) et les options th\u00e9rapeutiques disponibles, y compris les interventions pr\u00e9natales comme l\u2019occlusion trach\u00e9ale f\u0153toscopique (FETO). D\u2019autres pathologies thoraciques, comme les \u00e9panchements pleuraux, les masses m\u00e9diastinales et les anomalies du diaphragme, seront \u00e9galement abord\u00e9es. Enfin, nous discuterons des implications cliniques et de la prise en charge multidisciplinaire, en mettant l\u2019accent sur la surveillance \u00e9chographique, les d\u00e9cisions obst\u00e9tricales, la r\u00e9animation n\u00e9onatale et les interventions postnatales. Plan du cours 1. Introduction \u00e0 l\u2019\u00e9chographie du thorax f\u0153tal (10 min) Pr\u00e9sentation des objectifs du cours Importance de l\u2019\u00e9chographie pour l\u2019\u00e9tude du thorax f\u0153tal Techniques et principes de base de l\u2019\u00e9chographie thoracique f\u0153tale 2. Anatomie normale du thorax f\u0153tal (15 min) Structures principales \u00e0 analyser en \u00e9chographie : Poumons Diaphragme C\u0153ur et m\u00e9diastin Cage thoracique et c\u00f4tes Coupes \u00e9chographiques essentielles : Axiale Parasagittale Signes \u00e9chographiques d\u2019un d\u00e9veloppement pulmonaire normal 3. Techniques et strat\u00e9gies d\u2019\u00e9valuation \u00e9chographique (15 min) Techniques d\u2019imagerie : Mode 2D Doppler couleur Mode 3D (si applicable) Importance des mesures quantitatives : Lung-to-Head Ratio (LHR) Volume pulmonaire mesur\u00e9 en IRM 4. Malformations cong\u00e9nitales du thorax f\u0153tal (30 min) 4.1. Hernie diaphragmatique cong\u00e9nitale (HCD) (15 min) Physiopathologie et incidence Signes \u00e9chographiques : D\u00e9placement du c\u0153ur Position anormale de l\u2019estomac et du foie Outils pronostiques : LHR observ\u00e9\/attendu Position du foie et de l\u2019estomac 4.2. Malformations pulmonaires cong\u00e9nitales (15 min) Maladie ad\u00e9nomato\u00efde kystique pulmonaire (MAKP) S\u00e9questration pulmonaire Atr\u00e9sie bronchique Imagerie et diff\u00e9renciation \u00e9chographique 5. Autres pathologies thoraciques f\u0153tales (20 min) Chylothorax cong\u00e9nital Effusions pleurales Masses m\u00e9diastinales (kystes bronchog\u00e9niques, t\u00e9ratomes) 6. Implications cliniques et prise en charge (20 min) Importance du diagnostic pr\u00e9natal Surveillance \u00e9chographique des cas \u00e0 risque Approche multidisciplinaire et implications obst\u00e9tricales Options th\u00e9rapeutiques in utero (ex. occlusion trach\u00e9ale pour HCD) 7. Conclusion et discussion (10 min) Synth\u00e8se des points cl\u00e9s du cours Perspectives futures et d\u00e9veloppement des techniques d\u2019imagerie Questions et \u00e9changes avec les participants d\u00e9veloppement des chapitres du plan Chapitre 1 : Introduction \u00e0 l\u2019\u00e9chographie du thorax f\u0153tal 1.1. Objectifs du chapitre (2 min) Comprendre l\u2019int\u00e9r\u00eat de l\u2019\u00e9chographie dans l\u2019\u00e9valuation du thorax f\u0153tal Identifier les indications principales de l\u2019examen Appr\u00e9hender les limites et les d\u00e9fis diagnostiques 1.2. Importance de l\u2019\u00e9chographie thoracique f\u0153tale en m\u00e9decine pr\u00e9natale (3 min) R\u00f4le cl\u00e9 du diagnostic pr\u00e9natal D\u00e9tection des anomalies pulmonaires et diaphragmatique Anticipation des complications n\u00e9onatales Planification de la prise en charge obst\u00e9tricale et postnatale Comparaison avec d&rsquo;autres techniques d\u2019imagerie IRM f\u0153tale : compl\u00e9mentaire \u00e0 l\u2019\u00e9chographie pour le calcul du volume pulmonaire Radiographie et scanner postnatals : non r\u00e9alisables in utero, mais essentiels apr\u00e8s la naissance Indications principales de l\u2019\u00e9chographie thoracique f\u0153tale Suspicion de malformation pulmonaire (ex. hernie diaphragmatique cong\u00e9nitale, s\u00e9questration pulmonaire) Anomalie d\u00e9tect\u00e9e lors de l\u2019\u00e9chographie morphologique syst\u00e9matique Signes d\u2019hydrops f\u0153tal ou d\u2019\u00e9panchement pleural 1.3. Techniques et principes de base de l\u2019\u00e9chographie thoracique f\u0153tale (5 min) 1.3.1. Modes d\u2019imagerie utilis\u00e9s Mode 2D (B-mode) : Identification des structures thoraciques normales D\u00e9tection des masses ou des anomalies du diaphragme Doppler couleur et Doppler puls\u00e9 : Analyse des flux sanguins dans les vaisseaux pulmonaires et le c\u0153ur Identification d\u2019un \u00e9ventuel shunt vasculaire (ex. s\u00e9questration pulmonaire) Mode 3D\/4D (si disponible) : Reconstruction volumique des poumons Am\u00e9lioration de la visualisation des structures m\u00e9diastinales 1.3.2. Coupes \u00e9chographiques essentielles Coupe axiale standard (transversale) : Vue de r\u00e9f\u00e9rence pour \u00e9valuer les poumons et le c\u0153ur Identification de l\u2019estomac et du foie en cas de suspicion de hernie diaphragmatique Coupes longitudinales parasagittales : \u00c9valuation de la continuit\u00e9 du diaphragme V\u00e9rification de l\u2019emplacement des organes abdominaux Coupes coronalement orient\u00e9es : Appr\u00e9ciation de la sym\u00e9trie pulmonaire D\u00e9tection des \u00e9panchements pleuraux 1.3.3. Rep\u00e8res anatomiques cl\u00e9s en \u00e9chographie thoracique f\u0153tale Le c\u0153ur et son positionnement : \u00e9valuation du situs et du d\u00e9placement \u00e9ventuel Le diaphragme : pr\u00e9sence, continuit\u00e9 et concavit\u00e9 Les poumons : homog\u00e9n\u00e9it\u00e9, volume et vascularisation Le m\u00e9diastin : d\u00e9viation, compression des structures environnantes 1.4. Limites et d\u00e9fis diagnostiques (2 min) Facteurs influen\u00e7ant la qualit\u00e9 de l\u2019image \u00e9chographique : Position f\u0153tale d\u00e9favorable Oligohydramnios r\u00e9duisant la fen\u00eatre acoustique Ob\u00e9sit\u00e9 maternelle compliquant la transmission des ultrasons Probl\u00e8mes d\u2019interpr\u00e9tation possibles : Confusion entre certaines malformations (ex. s\u00e9questration pulmonaire vs. maladie ad\u00e9nomato\u00efde kystique pulmonaire) Estimation difficile du pronostic en cas de l\u00e9sions complexes Compl\u00e9mentarit\u00e9 avec l\u2019IRM f\u0153tale : Pr\u00e9cision accrue pour le volume pulmonaire et la diff\u00e9renciation tissulaire Meilleure \u00e9valuation des structures m\u00e9diastinales Chapitre 2 : Anatomie normale du thorax f\u0153tal 2.1. Introduction et objectifs du chapitre (2 min) Comprendre l\u2019organisation anatomique du thorax f\u0153tal Apprendre \u00e0 identifier les structures thoraciques normales en \u00e9chographie Savoir diff\u00e9rencier un d\u00e9veloppement pulmonaire normal d\u2019un d\u00e9veloppement pathologique 2.2. Structures principales \u00e0 analyser en \u00e9chographie thoracique f\u0153tale (5 min) 2.2.1. Poumons f\u0153taux D\u00e9veloppement embryologique et phases de maturation : Phase pseudoglandulaire (5-17 SA) Phase canaliculaire (16-26 SA) Phase sacculaire (24-36 SA) Phase alv\u00e9olaire (\u00e0 partir de 36 SA) Aspect \u00e9chographique normal : \u00c9chog\u00e9nicit\u00e9 homog\u00e8ne au 2e trimestre Augmentation progressive de l\u2019\u00e9chog\u00e9nicit\u00e9 au 3e trimestre Sym\u00e9trie des poumons droit et gauche 2.2.2. Diaphragme Structure musculo-tendineuse s\u00e9parant le thorax et l\u2019abdomen Crit\u00e8res \u00e9chographiques d\u2019un diaphragme normal : Ligne hyper\u00e9chog\u00e8ne continue Concavit\u00e9 dirig\u00e9e vers l\u2019abdomen Absence de solution de continuit\u00e9 2.2.3. C\u0153ur et m\u00e9diastin \u00c9valuation du positionnement cardiaque : C\u0153ur situ\u00e9 \u00e0 gauche Apex dirig\u00e9 \u00e0 45\u00b0 vers la gauche Structures m\u00e9diastinales visibles : Thymus : aspect homog\u00e8ne &hellip;<\/p>\n<p class=\"read-more\"> <a class=\"\" href=\"http:\/\/echonews.fr\/?page_id=5032\"> <span class=\"screen-reader-text\">AI-Thorax-Foetal<\/span> Lire la suite\u00a0\u00bb<\/a><\/p>\n","protected":false},"author":5,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_canvas","meta":{"_eb_attr":"","site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"full-width-container","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-gradient":""}},"footnotes":""},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.3 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>AI-Thorax-Foetal -<\/title>\n<meta name=\"robots\" content=\"noindex, nofollow\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"AI-Thorax-Foetal -\" \/>\n<meta property=\"og:description\" content=\"\u00c9chographie du thorax f\u0153tal : De l&#8217;anatomie normale aux malformations complexes Demo Demo Dr Pierre Dupont Hm-envelop Linkedin X-twitter Dr Margaret Smith Hm-envelop Linkedin Dr Fran\u00e7ois durand Hm-envelop Youtube Linkedin Ce cours, d\u2019une dur\u00e9e de deux heures, vise \u00e0 fournir aux participants une approche compl\u00e8te et structur\u00e9e de l\u2019\u00e9chographie du thorax f\u0153tal, allant de l\u2019anatomie normale aux malformations les plus complexes. Dans un premier temps, nous aborderons les bases de l\u2019\u00e9chographie thoracique, en d\u00e9taillant les techniques d\u2019imagerie utilis\u00e9es, les coupes \u00e9chographiques essentielles et les crit\u00e8res d\u2019\u00e9valuation des structures thoraciques normales. Cette compr\u00e9hension de l\u2019anatomie normale est indispensable pour identifier toute anomalie et en \u00e9valuer la s\u00e9v\u00e9rit\u00e9. Nous explorerons ensuite les principales malformations cong\u00e9nitales, notamment la hernie diaphragmatique cong\u00e9nitale (HDC) et les malformations pulmonaires cong\u00e9nitales telles que la maladie ad\u00e9nomato\u00efde kystique pulmonaire (MAKP) et la s\u00e9questration pulmonaire. L\u2019accent sera mis sur les signes \u00e9chographiques distinctifs, les outils pronostiques comme le Lung-to-Head Ratio (LHR) et les options th\u00e9rapeutiques disponibles, y compris les interventions pr\u00e9natales comme l\u2019occlusion trach\u00e9ale f\u0153toscopique (FETO). D\u2019autres pathologies thoraciques, comme les \u00e9panchements pleuraux, les masses m\u00e9diastinales et les anomalies du diaphragme, seront \u00e9galement abord\u00e9es. Enfin, nous discuterons des implications cliniques et de la prise en charge multidisciplinaire, en mettant l\u2019accent sur la surveillance \u00e9chographique, les d\u00e9cisions obst\u00e9tricales, la r\u00e9animation n\u00e9onatale et les interventions postnatales. Plan du cours 1. Introduction \u00e0 l\u2019\u00e9chographie du thorax f\u0153tal (10 min) Pr\u00e9sentation des objectifs du cours Importance de l\u2019\u00e9chographie pour l\u2019\u00e9tude du thorax f\u0153tal Techniques et principes de base de l\u2019\u00e9chographie thoracique f\u0153tale 2. Anatomie normale du thorax f\u0153tal (15 min) Structures principales \u00e0 analyser en \u00e9chographie : Poumons Diaphragme C\u0153ur et m\u00e9diastin Cage thoracique et c\u00f4tes Coupes \u00e9chographiques essentielles : Axiale Parasagittale Signes \u00e9chographiques d\u2019un d\u00e9veloppement pulmonaire normal 3. Techniques et strat\u00e9gies d\u2019\u00e9valuation \u00e9chographique (15 min) Techniques d\u2019imagerie : Mode 2D Doppler couleur Mode 3D (si applicable) Importance des mesures quantitatives : Lung-to-Head Ratio (LHR) Volume pulmonaire mesur\u00e9 en IRM 4. Malformations cong\u00e9nitales du thorax f\u0153tal (30 min) 4.1. Hernie diaphragmatique cong\u00e9nitale (HCD) (15 min) Physiopathologie et incidence Signes \u00e9chographiques : D\u00e9placement du c\u0153ur Position anormale de l\u2019estomac et du foie Outils pronostiques : LHR observ\u00e9\/attendu Position du foie et de l\u2019estomac 4.2. Malformations pulmonaires cong\u00e9nitales (15 min) Maladie ad\u00e9nomato\u00efde kystique pulmonaire (MAKP) S\u00e9questration pulmonaire Atr\u00e9sie bronchique Imagerie et diff\u00e9renciation \u00e9chographique 5. Autres pathologies thoraciques f\u0153tales (20 min) Chylothorax cong\u00e9nital Effusions pleurales Masses m\u00e9diastinales (kystes bronchog\u00e9niques, t\u00e9ratomes) 6. Implications cliniques et prise en charge (20 min) Importance du diagnostic pr\u00e9natal Surveillance \u00e9chographique des cas \u00e0 risque Approche multidisciplinaire et implications obst\u00e9tricales Options th\u00e9rapeutiques in utero (ex. occlusion trach\u00e9ale pour HCD) 7. Conclusion et discussion (10 min) Synth\u00e8se des points cl\u00e9s du cours Perspectives futures et d\u00e9veloppement des techniques d\u2019imagerie Questions et \u00e9changes avec les participants d\u00e9veloppement des chapitres du plan Chapitre 1 : Introduction \u00e0 l\u2019\u00e9chographie du thorax f\u0153tal 1.1. Objectifs du chapitre (2 min) Comprendre l\u2019int\u00e9r\u00eat de l\u2019\u00e9chographie dans l\u2019\u00e9valuation du thorax f\u0153tal Identifier les indications principales de l\u2019examen Appr\u00e9hender les limites et les d\u00e9fis diagnostiques 1.2. Importance de l\u2019\u00e9chographie thoracique f\u0153tale en m\u00e9decine pr\u00e9natale (3 min) R\u00f4le cl\u00e9 du diagnostic pr\u00e9natal D\u00e9tection des anomalies pulmonaires et diaphragmatique Anticipation des complications n\u00e9onatales Planification de la prise en charge obst\u00e9tricale et postnatale Comparaison avec d&rsquo;autres techniques d\u2019imagerie IRM f\u0153tale : compl\u00e9mentaire \u00e0 l\u2019\u00e9chographie pour le calcul du volume pulmonaire Radiographie et scanner postnatals : non r\u00e9alisables in utero, mais essentiels apr\u00e8s la naissance Indications principales de l\u2019\u00e9chographie thoracique f\u0153tale Suspicion de malformation pulmonaire (ex. hernie diaphragmatique cong\u00e9nitale, s\u00e9questration pulmonaire) Anomalie d\u00e9tect\u00e9e lors de l\u2019\u00e9chographie morphologique syst\u00e9matique Signes d\u2019hydrops f\u0153tal ou d\u2019\u00e9panchement pleural 1.3. Techniques et principes de base de l\u2019\u00e9chographie thoracique f\u0153tale (5 min) 1.3.1. Modes d\u2019imagerie utilis\u00e9s Mode 2D (B-mode) : Identification des structures thoraciques normales D\u00e9tection des masses ou des anomalies du diaphragme Doppler couleur et Doppler puls\u00e9 : Analyse des flux sanguins dans les vaisseaux pulmonaires et le c\u0153ur Identification d\u2019un \u00e9ventuel shunt vasculaire (ex. s\u00e9questration pulmonaire) Mode 3D\/4D (si disponible) : Reconstruction volumique des poumons Am\u00e9lioration de la visualisation des structures m\u00e9diastinales 1.3.2. Coupes \u00e9chographiques essentielles Coupe axiale standard (transversale) : Vue de r\u00e9f\u00e9rence pour \u00e9valuer les poumons et le c\u0153ur Identification de l\u2019estomac et du foie en cas de suspicion de hernie diaphragmatique Coupes longitudinales parasagittales : \u00c9valuation de la continuit\u00e9 du diaphragme V\u00e9rification de l\u2019emplacement des organes abdominaux Coupes coronalement orient\u00e9es : Appr\u00e9ciation de la sym\u00e9trie pulmonaire D\u00e9tection des \u00e9panchements pleuraux 1.3.3. Rep\u00e8res anatomiques cl\u00e9s en \u00e9chographie thoracique f\u0153tale Le c\u0153ur et son positionnement : \u00e9valuation du situs et du d\u00e9placement \u00e9ventuel Le diaphragme : pr\u00e9sence, continuit\u00e9 et concavit\u00e9 Les poumons : homog\u00e9n\u00e9it\u00e9, volume et vascularisation Le m\u00e9diastin : d\u00e9viation, compression des structures environnantes 1.4. Limites et d\u00e9fis diagnostiques (2 min) Facteurs influen\u00e7ant la qualit\u00e9 de l\u2019image \u00e9chographique : Position f\u0153tale d\u00e9favorable Oligohydramnios r\u00e9duisant la fen\u00eatre acoustique Ob\u00e9sit\u00e9 maternelle compliquant la transmission des ultrasons Probl\u00e8mes d\u2019interpr\u00e9tation possibles : Confusion entre certaines malformations (ex. s\u00e9questration pulmonaire vs. maladie ad\u00e9nomato\u00efde kystique pulmonaire) Estimation difficile du pronostic en cas de l\u00e9sions complexes Compl\u00e9mentarit\u00e9 avec l\u2019IRM f\u0153tale : Pr\u00e9cision accrue pour le volume pulmonaire et la diff\u00e9renciation tissulaire Meilleure \u00e9valuation des structures m\u00e9diastinales Chapitre 2 : Anatomie normale du thorax f\u0153tal 2.1. Introduction et objectifs du chapitre (2 min) Comprendre l\u2019organisation anatomique du thorax f\u0153tal Apprendre \u00e0 identifier les structures thoraciques normales en \u00e9chographie Savoir diff\u00e9rencier un d\u00e9veloppement pulmonaire normal d\u2019un d\u00e9veloppement pathologique 2.2. Structures principales \u00e0 analyser en \u00e9chographie thoracique f\u0153tale (5 min) 2.2.1. Poumons f\u0153taux D\u00e9veloppement embryologique et phases de maturation : Phase pseudoglandulaire (5-17 SA) Phase canaliculaire (16-26 SA) Phase sacculaire (24-36 SA) Phase alv\u00e9olaire (\u00e0 partir de 36 SA) Aspect \u00e9chographique normal : \u00c9chog\u00e9nicit\u00e9 homog\u00e8ne au 2e trimestre Augmentation progressive de l\u2019\u00e9chog\u00e9nicit\u00e9 au 3e trimestre Sym\u00e9trie des poumons droit et gauche 2.2.2. Diaphragme Structure musculo-tendineuse s\u00e9parant le thorax et l\u2019abdomen Crit\u00e8res \u00e9chographiques d\u2019un diaphragme normal : Ligne hyper\u00e9chog\u00e8ne continue Concavit\u00e9 dirig\u00e9e vers l\u2019abdomen Absence de solution de continuit\u00e9 2.2.3. C\u0153ur et m\u00e9diastin \u00c9valuation du positionnement cardiaque : C\u0153ur situ\u00e9 \u00e0 gauche Apex dirig\u00e9 \u00e0 45\u00b0 vers la gauche Structures m\u00e9diastinales visibles : Thymus : aspect homog\u00e8ne &hellip; AI-Thorax-Foetal Lire la suite\u00a0\u00bb\" \/>\n<meta property=\"og:url\" content=\"http:\/\/echonews.fr\/?page_id=5032\" \/>\n<meta property=\"article:modified_time\" content=\"2025-02-26T13:04:30+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Bandeau-accueil-cours-thorax.jpg\" \/>\n<meta name=\"twitter:label1\" content=\"Dur\u00e9e de lecture estim\u00e9e\" \/>\n\t<meta name=\"twitter:data1\" content=\"84 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"http:\/\/echonews.fr\/?page_id=5032\",\"url\":\"http:\/\/echonews.fr\/?page_id=5032\",\"name\":\"AI-Thorax-Foetal -\",\"isPartOf\":{\"@id\":\"http:\/\/echonews.fr\/#website\"},\"primaryImageOfPage\":{\"@id\":\"http:\/\/echonews.fr\/?page_id=5032#primaryimage\"},\"image\":{\"@id\":\"http:\/\/echonews.fr\/?page_id=5032#primaryimage\"},\"thumbnailUrl\":\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Bandeau-accueil-cours-thorax.jpg\",\"datePublished\":\"2025-02-25T08:40:17+00:00\",\"dateModified\":\"2025-02-26T13:04:30+00:00\",\"breadcrumb\":{\"@id\":\"http:\/\/echonews.fr\/?page_id=5032#breadcrumb\"},\"inLanguage\":\"fr-FR\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"http:\/\/echonews.fr\/?page_id=5032\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"fr-FR\",\"@id\":\"http:\/\/echonews.fr\/?page_id=5032#primaryimage\",\"url\":\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Bandeau-accueil-cours-thorax.jpg\",\"contentUrl\":\"http:\/\/echonews.fr\/wp-content\/uploads\/2025\/02\/Bandeau-accueil-cours-thorax.jpg\",\"width\":2560,\"height\":1106},{\"@type\":\"BreadcrumbList\",\"@id\":\"http:\/\/echonews.fr\/?page_id=5032#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Accueil\",\"item\":\"http:\/\/echonews.fr\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"AI-Thorax-Foetal\"}]},{\"@type\":\"WebSite\",\"@id\":\"http:\/\/echonews.fr\/#website\",\"url\":\"http:\/\/echonews.fr\/\",\"name\":\"\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"http:\/\/echonews.fr\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"fr-FR\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"AI-Thorax-Foetal -","robots":{"index":"noindex","follow":"nofollow"},"og_locale":"fr_FR","og_type":"article","og_title":"AI-Thorax-Foetal -","og_description":"\u00c9chographie du thorax f\u0153tal : De l&#8217;anatomie normale aux malformations complexes Demo Demo Dr Pierre Dupont Hm-envelop Linkedin X-twitter Dr Margaret Smith Hm-envelop Linkedin Dr Fran\u00e7ois durand Hm-envelop Youtube Linkedin Ce cours, d\u2019une dur\u00e9e de deux heures, vise \u00e0 fournir aux participants une approche compl\u00e8te et structur\u00e9e de l\u2019\u00e9chographie du thorax f\u0153tal, allant de l\u2019anatomie normale aux malformations les plus complexes. Dans un premier temps, nous aborderons les bases de l\u2019\u00e9chographie thoracique, en d\u00e9taillant les techniques d\u2019imagerie utilis\u00e9es, les coupes \u00e9chographiques essentielles et les crit\u00e8res d\u2019\u00e9valuation des structures thoraciques normales. Cette compr\u00e9hension de l\u2019anatomie normale est indispensable pour identifier toute anomalie et en \u00e9valuer la s\u00e9v\u00e9rit\u00e9. Nous explorerons ensuite les principales malformations cong\u00e9nitales, notamment la hernie diaphragmatique cong\u00e9nitale (HDC) et les malformations pulmonaires cong\u00e9nitales telles que la maladie ad\u00e9nomato\u00efde kystique pulmonaire (MAKP) et la s\u00e9questration pulmonaire. L\u2019accent sera mis sur les signes \u00e9chographiques distinctifs, les outils pronostiques comme le Lung-to-Head Ratio (LHR) et les options th\u00e9rapeutiques disponibles, y compris les interventions pr\u00e9natales comme l\u2019occlusion trach\u00e9ale f\u0153toscopique (FETO). D\u2019autres pathologies thoraciques, comme les \u00e9panchements pleuraux, les masses m\u00e9diastinales et les anomalies du diaphragme, seront \u00e9galement abord\u00e9es. Enfin, nous discuterons des implications cliniques et de la prise en charge multidisciplinaire, en mettant l\u2019accent sur la surveillance \u00e9chographique, les d\u00e9cisions obst\u00e9tricales, la r\u00e9animation n\u00e9onatale et les interventions postnatales. Plan du cours 1. Introduction \u00e0 l\u2019\u00e9chographie du thorax f\u0153tal (10 min) Pr\u00e9sentation des objectifs du cours Importance de l\u2019\u00e9chographie pour l\u2019\u00e9tude du thorax f\u0153tal Techniques et principes de base de l\u2019\u00e9chographie thoracique f\u0153tale 2. Anatomie normale du thorax f\u0153tal (15 min) Structures principales \u00e0 analyser en \u00e9chographie : Poumons Diaphragme C\u0153ur et m\u00e9diastin Cage thoracique et c\u00f4tes Coupes \u00e9chographiques essentielles : Axiale Parasagittale Signes \u00e9chographiques d\u2019un d\u00e9veloppement pulmonaire normal 3. Techniques et strat\u00e9gies d\u2019\u00e9valuation \u00e9chographique (15 min) Techniques d\u2019imagerie : Mode 2D Doppler couleur Mode 3D (si applicable) Importance des mesures quantitatives : Lung-to-Head Ratio (LHR) Volume pulmonaire mesur\u00e9 en IRM 4. Malformations cong\u00e9nitales du thorax f\u0153tal (30 min) 4.1. Hernie diaphragmatique cong\u00e9nitale (HCD) (15 min) Physiopathologie et incidence Signes \u00e9chographiques : D\u00e9placement du c\u0153ur Position anormale de l\u2019estomac et du foie Outils pronostiques : LHR observ\u00e9\/attendu Position du foie et de l\u2019estomac 4.2. Malformations pulmonaires cong\u00e9nitales (15 min) Maladie ad\u00e9nomato\u00efde kystique pulmonaire (MAKP) S\u00e9questration pulmonaire Atr\u00e9sie bronchique Imagerie et diff\u00e9renciation \u00e9chographique 5. Autres pathologies thoraciques f\u0153tales (20 min) Chylothorax cong\u00e9nital Effusions pleurales Masses m\u00e9diastinales (kystes bronchog\u00e9niques, t\u00e9ratomes) 6. Implications cliniques et prise en charge (20 min) Importance du diagnostic pr\u00e9natal Surveillance \u00e9chographique des cas \u00e0 risque Approche multidisciplinaire et implications obst\u00e9tricales Options th\u00e9rapeutiques in utero (ex. occlusion trach\u00e9ale pour HCD) 7. Conclusion et discussion (10 min) Synth\u00e8se des points cl\u00e9s du cours Perspectives futures et d\u00e9veloppement des techniques d\u2019imagerie Questions et \u00e9changes avec les participants d\u00e9veloppement des chapitres du plan Chapitre 1 : Introduction \u00e0 l\u2019\u00e9chographie du thorax f\u0153tal 1.1. Objectifs du chapitre (2 min) Comprendre l\u2019int\u00e9r\u00eat de l\u2019\u00e9chographie dans l\u2019\u00e9valuation du thorax f\u0153tal Identifier les indications principales de l\u2019examen Appr\u00e9hender les limites et les d\u00e9fis diagnostiques 1.2. Importance de l\u2019\u00e9chographie thoracique f\u0153tale en m\u00e9decine pr\u00e9natale (3 min) R\u00f4le cl\u00e9 du diagnostic pr\u00e9natal D\u00e9tection des anomalies pulmonaires et diaphragmatique Anticipation des complications n\u00e9onatales Planification de la prise en charge obst\u00e9tricale et postnatale Comparaison avec d&rsquo;autres techniques d\u2019imagerie IRM f\u0153tale : compl\u00e9mentaire \u00e0 l\u2019\u00e9chographie pour le calcul du volume pulmonaire Radiographie et scanner postnatals : non r\u00e9alisables in utero, mais essentiels apr\u00e8s la naissance Indications principales de l\u2019\u00e9chographie thoracique f\u0153tale Suspicion de malformation pulmonaire (ex. hernie diaphragmatique cong\u00e9nitale, s\u00e9questration pulmonaire) Anomalie d\u00e9tect\u00e9e lors de l\u2019\u00e9chographie morphologique syst\u00e9matique Signes d\u2019hydrops f\u0153tal ou d\u2019\u00e9panchement pleural 1.3. Techniques et principes de base de l\u2019\u00e9chographie thoracique f\u0153tale (5 min) 1.3.1. Modes d\u2019imagerie utilis\u00e9s Mode 2D (B-mode) : Identification des structures thoraciques normales D\u00e9tection des masses ou des anomalies du diaphragme Doppler couleur et Doppler puls\u00e9 : Analyse des flux sanguins dans les vaisseaux pulmonaires et le c\u0153ur Identification d\u2019un \u00e9ventuel shunt vasculaire (ex. s\u00e9questration pulmonaire) Mode 3D\/4D (si disponible) : Reconstruction volumique des poumons Am\u00e9lioration de la visualisation des structures m\u00e9diastinales 1.3.2. Coupes \u00e9chographiques essentielles Coupe axiale standard (transversale) : Vue de r\u00e9f\u00e9rence pour \u00e9valuer les poumons et le c\u0153ur Identification de l\u2019estomac et du foie en cas de suspicion de hernie diaphragmatique Coupes longitudinales parasagittales : \u00c9valuation de la continuit\u00e9 du diaphragme V\u00e9rification de l\u2019emplacement des organes abdominaux Coupes coronalement orient\u00e9es : Appr\u00e9ciation de la sym\u00e9trie pulmonaire D\u00e9tection des \u00e9panchements pleuraux 1.3.3. Rep\u00e8res anatomiques cl\u00e9s en \u00e9chographie thoracique f\u0153tale Le c\u0153ur et son positionnement : \u00e9valuation du situs et du d\u00e9placement \u00e9ventuel Le diaphragme : pr\u00e9sence, continuit\u00e9 et concavit\u00e9 Les poumons : homog\u00e9n\u00e9it\u00e9, volume et vascularisation Le m\u00e9diastin : d\u00e9viation, compression des structures environnantes 1.4. Limites et d\u00e9fis diagnostiques (2 min) Facteurs influen\u00e7ant la qualit\u00e9 de l\u2019image \u00e9chographique : Position f\u0153tale d\u00e9favorable Oligohydramnios r\u00e9duisant la fen\u00eatre acoustique Ob\u00e9sit\u00e9 maternelle compliquant la transmission des ultrasons Probl\u00e8mes d\u2019interpr\u00e9tation possibles : Confusion entre certaines malformations (ex. s\u00e9questration pulmonaire vs. maladie ad\u00e9nomato\u00efde kystique pulmonaire) Estimation difficile du pronostic en cas de l\u00e9sions complexes Compl\u00e9mentarit\u00e9 avec l\u2019IRM f\u0153tale : Pr\u00e9cision accrue pour le volume pulmonaire et la diff\u00e9renciation tissulaire Meilleure \u00e9valuation des structures m\u00e9diastinales Chapitre 2 : Anatomie normale du thorax f\u0153tal 2.1. Introduction et objectifs du chapitre (2 min) Comprendre l\u2019organisation anatomique du thorax f\u0153tal Apprendre \u00e0 identifier les structures thoraciques normales en \u00e9chographie Savoir diff\u00e9rencier un d\u00e9veloppement pulmonaire normal d\u2019un d\u00e9veloppement pathologique 2.2. Structures principales \u00e0 analyser en \u00e9chographie thoracique f\u0153tale (5 min) 2.2.1. Poumons f\u0153taux D\u00e9veloppement embryologique et phases de maturation : Phase pseudoglandulaire (5-17 SA) Phase canaliculaire (16-26 SA) Phase sacculaire (24-36 SA) Phase alv\u00e9olaire (\u00e0 partir de 36 SA) Aspect \u00e9chographique normal : \u00c9chog\u00e9nicit\u00e9 homog\u00e8ne au 2e trimestre Augmentation progressive de l\u2019\u00e9chog\u00e9nicit\u00e9 au 3e trimestre Sym\u00e9trie des poumons droit et gauche 2.2.2. Diaphragme Structure musculo-tendineuse s\u00e9parant le thorax et l\u2019abdomen Crit\u00e8res \u00e9chographiques d\u2019un diaphragme normal : Ligne hyper\u00e9chog\u00e8ne continue Concavit\u00e9 dirig\u00e9e vers l\u2019abdomen Absence de solution de continuit\u00e9 2.2.3. 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