Clubfoot

• Ultrasound images showed the bones of the foot in the same plane as those of the tibia & fibula, c/w clubfoot

• Associated with a variety of syndromes, as well as oligohydromanios

What associated lab test might help confirm your diagnosis?

What does this image demonstrate and how does this affect your DDx?

Different Patient
Findings? How is this different from the previous case, if at all? What abnormal lab value might be expected?

Chamber view

Hypoplastic Left Ventricle

Image shows a hypoplastic left ventricle, which is smaller than the right ventricle

Pericardial Effusion

• Long arrow demonstrates a small pericardial effusion
• Arrowheads also show marked skin thickening, consistent with fetal hydrops

12 wk fetus

Different patient: 16-20 wk fetus

How Do These Findings Relate to the Prior image?

Answers:

Diaphragmatic Hernia (Bockdalek)

• Coronal view of the thorax and abdomen demonstrates the stomach (ST) and bowel (BO) in the left hemithorax
• Consistent with congenital diaphragmatic hernia

Answers:

Cystic Adenomatoid Malformation

• Arrows indicate a large mass in the left hemithorax that is displacing the heart: consistent with Type II CCAM
• DDx: Diaphragmatic hernia, sequestration, congential lobar emphysema

What’s shown in this image & how does it relate to the previously-shown video clip?

Try to name the lesion marked with arrows

Answers:

Sacrococcygeal Teratoma:

• Arrowheads show the end of the sacral spine; arrows indicate a large, complex mass arising in this area.
• Usually do not undergo malignant degeneration in-utero, but should be removed shortly after birth (by ~ 6 mos at latest).

6.5 wk embryo : Identify structures.  At what point they should be seen?	(2nd trimester) : Identify Structures
Identify Structures	Assessment of AFI (subjective)

 what are the shown structures?

Answers

Screening US:

X Last Image

Diagnosis: 

Vein of Galen “Aneurysm”:

Hx of Multiple Spontaneous Abortions
Later in pregnancy. Real-time US verifies only 1 fetus (i.e., twins are not present). Dx?
A search through the patient’s X-Ray jacket yields the above image (pre-pregnancy). Final Dx?
 

Placental Abruption

There is a hypoechoic hematoma (long arrow and calipers) lifting the edge of the placenta (short arrow).

Also seen are placental calcifications, which are normal. These can be graded 0 to 3 as the pregnancy matures.(*significance controversial- placentas are not graded in all practices)

Dandy-Walker Malformation

Dandy-Walker Malformation-Axial image of the posterior fossa demonstrates absence of the cerebellar vermis as well as splaying and flattening of the cerebellar hemispheres (arrowheads) by a large fluid-filled space (*) connecting the fourth ventricle to the cisterna magna

Thanatophoric Dysplasia

Image from a fetus with Thanatophoric Dysplasia shows a cloverleaf skull ( = Kleeblattschadel), with frontal bossing (arrows) and lateral protrusion in the region of the temporal lobes (arrowheads)

Skull abnormality, through somewhat characterstic, only seen in 14%

• More commonly polyhydramnios (71%), extremely small thorax

DDX: fetal demise, with overlapping skull fragments, can appear similar