Atlas of Ultrasound in Obstetrics and Gynecology

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Preface v
Acknowledgments vii
S E C T I O N
I Obstetrical Ultrasound 1
Normal Anatomy

1 First Trimester 3 1.1.
Normal Pregnancy Prior to 6 Weeks of Gestation 3 1.2.
Normal Pregnancy at 6–10 Weeks of Gestation 6 1.3.
Normal Pregnancy at 10–14 Weeks of Gestation 10 2
Second and Third Trimester Fetal Anatomy 15 2.1.
Head 15 2.2.
Face 18 2.3.
Spine 22 2.4.
Neck and Thorax 24 2.5.
Heart 27 2.6.
Abdomen 30 2.7.
Extremities 35 3
Second and Third Trimester Nonfetal Components 40 3.1.
Umbilical Cord 40 3.2.
Cervix in Pregnancy 43 3.3.
Placenta 45 3.4.

Amniotic Fluid 46
Fetal Abnormalities

4 Head 49 4.1.
Hydrocephalus 49 4.2.
Aqueductal Stenosis 51 4.3.
Dandy-Walker Malformation 52 4.4.
Anencephaly 54 4.5.
Encephalocele 56 4.6.
Agenesis of the Corpus Callosum 59 4.7.
Holoprosencephaly 60 4.8.
Vein of Galen Aneurysm 62 4.9.
Intracranial Hemorrhage and Porencephaly 64 4.10.
Schizencephaly 67 4.11.
Septo-Optic Dysplasia 68 4.12.
Hydranencephaly 70 4.13.
Cytomegalovirus and Other in Utero Infections 73 4.14.
Arachnoid Cyst 75 4.15.
Intracranial Tumors 78 4.16.
Lissencephaly 81 4.17.
Craniosynostosis 83 5
Spine 85 5.1.
Spina Bifi da and Meningomyelocele 85 5.2.
Hemivertebra 90 5.3.
Scoliosis 92 5.4.
Caudal Regression and Sacral Agenesis 93 5.5.
Sacrococcygeal Teratoma 96 6
Face 100 6.1.
Cleft Lip and Palate 100 6.2.
Macroglossia 104 6.3.
Micrognathia 106 6.4.
Hypotelorism 107 6.5.
Cyclopia and Proboscis 109 6.6.
Microphthalmia and Anophthalmia 111 6.7.
Cysts and Tumors 112 7
Neck 114 7.1.
Thickened Nuchal Translucency (10–14 Weeks of Gestation) 114 7.2.
Thickened Nuchal Fold (16–20 Weeks of Gestation) 116 7.3.
Cystic Hygroma 117 7.4.
Masses 120 7.5.
Goiter 121 8
Thorax 123 8.1.
Pulmonary Masses and Dysplasias 123 8.2.
Tracheal and Bronchial Atresia 130 8.3.
Unilateral Pulmonary Agenesis 131 8.4.
Diaphragmatic Hernia 132 8.5.
Pleural Effusion and Hydrops 136 9
Heart 141 9.1.
Overview of Congenital Heart Disease 141 9.2.
Hypoplastic Left Heart Syndrome and Aortic Stenosis 141 9.3.
Hypoplastic Right Ventricle and Pulmonic Stenosis 145 9.4.
Ebstein Anomaly 147 9.5.
Ventricular Septal Defect 149 9.6.
Atrioventricular Canal 150 9.7.
Tetralogy of Fallot 152 9.8.
Transposition of the Great Vessels 153 9.9.
Truncus Arteriosus 155 9.10.
Double Outlet Right Ventricle 155 9.11.
Myocardial Tumors 157 9.12.
Arrhythmias 159 9.13.
Ectopia Cordis 161 9.14.
Pericardial Effusion 162 10
Gastrointestinal Tract 164 10.1.
Esophageal Atresia 164 10.2.
Duodenal Atresia 165 10.3.
Small Bowel Obstruction 167 10.4.
Meconium Peritonitis 168 10.5.
Cholelithiasis 171 10.6.
Liver Masses, Cysts, and Calcifi cations 172 11
Ventral Wall 175 11.1.
Omphalocele 175 11.2.
Gastroschisis 177 11.3.
Amniotic Band Syndrome 180 12
Genitourinary Tract 182 12.1.
Unilateral and Bilateral Renal Agenesis 182 12.2.
Hydronephrosis: Overview 185 12.3.
Ureteropelvic Junction Obstruction 188 12.4.
Vesicoureteral Refl ux and Primary Megaureter 190 12.5.
Posterior Urethral Valves and Urethral Atresia 191 12.6.
Prune Belly Syndrome 194 12.7.
Multicystic Dysplastic Kidney and Renal Dysplasia from Obstruction 195 12.8.
Hereditary Polycystic Kidney Disease 199 12.9.
Renal Ectopia 200 12.10.
Mesoblastic Nephroma 202 12.11.
Duplicated Collecting System and Ectopic Ureterocele 204 12.12.
Ovarian Cysts and Masses 205 12.13.
Cloacal and Bladder Exstrophy 207 12.14.
Abnormal External Genitalia 208 13
Extremities 212 13.1.
Skeletal Dysplasia 212 13.2.
Skeletal Dysostoses 219 13.3.
Amputations and Limb Reduction Defects 221 13.4.
Radial Ray Defects 224 13.5.
Polydactyly 226 13.6.
Overlapping Fingers and Clinodactyly 228 13.7.
Clubfoot 230 13.8.
Rocker Bottom Foot 231 14
Chromosomal Anomalies 232 14.1.
Trisomy 13 (Patau Syndrome) 232 14.2.
Trisomy 18 (Edwards Syndrome) 236 14.3.
Trisomy 21 (Down Syndrome) 241 14.4.
Monosomy X (Turner Syndrome, 45X) 245 14.5.
Triploidy 247 14.6.
DiGeorge Syndrome (22-q11 Deletion) 251
Non-Fetal Abnormalities

15 First Trimester Pregnancy Complications 253 15.1.
Failed Pregnancy 253 15.2.
Subchorionic Hematoma 255 15.3.
Slow Embryonic Heart Rate 256 16
Placenta 259 16.1.
Placenta Previa 259 16.2.
Placental Abruption 262 16.3.
Placenta Accreta, Increta, and Percreta 264 16.4.
Chorioangioma 268 17
Uterus and Cervix 270 17.1.
Cervical Incompetence 270 17.2.
Fibroids in Pregnancy 274 17.3.
Uterine Synechia and Amniotic Sheet 276 17.4.
Uterine Rupture 277 17.5.
Uterine Incarceration 278 18
Amniotic Fluid 281 18.1.
Oligohydramnios 281 18.2.
Polyhydramnios 283 18.3.
Intra-amniotic Hemorrhage 285 18.4.
Chorioamnionitis 286 19
Umbilical Cord 287 19.1.
Single Umbilical Artery 287 19.2.
Abnormal Placental Cord Insertions and Vasa Previa 289 19.3.
Allantoic Duct Cysts 291 19.4.
Umbilical Arterial Doppler 292 19.5.
Umbilical Venous Varix 294 19.6.
Nuchal Cord 296
Multiple Gestations

20 Diagnosis and Characterization of Multiple Gestations 298 20.1.
Fetal Number 298 20.2.
Placentation: Chorionicity and Amnionicity 303 21
Complications of Multiple Gestations 308 21.1.
Twin–Twin Transfusion Syndrome 308 21.2.
Acardiac Twinning 310 21.3.
Cord Entanglement in Monoamniotic Twins 312 21.4.
Conjoined Twins 314 21.5.
Death of One Twin In Utero 318
Procedures

22 Diagnostic Obstetrical Procedures 320 22.1.
Amniocentesis 320 22.2.
Chorionic Villus Sampling 322 22.3.
Percutaneous Umbilical Blood Sampling 323 23
Therapeutic Obstetrical Procedures 326 23.1.
Fetal Blood Transfusion 326 23.2.
Thoracentesis and Thoracoamniotic Shunting 328 23.3.
Bladder Drainage and Vesicoamniotic Shunting 330C O N T E N T S
xiii23.4.
Paracentesis 333 23.5.
Treatment of Cardiac Anomalies 334 23.6.
Ex Utero Intrapartum Treatment Procedure 338 23.7.
Removal of Intrauterine Device During Pregnancy 340 23.8.

Treatment of Complications of Multiple Gestations 341

S E C T I O N
II Gynecological Ultrasound 345
Normal Anatomy

24 Uterus 347 24.1.
Myometrium 347 24.2.
Endometrium 348 25
Adnexa 351 25.1.
Ovaries 351 25.2.
Extraovarian Adnexal Structures 354
Pathology

26 Myometrium 355 26.1.
Fibroids (Leiomyomas) and Leiomyosarcomas 355 26.2.
Adenomyosis 362 26.3.
Congenital Uterine Anomalies 363 27
Endometrium 368 27.1.
Endometrial Polyps 368 27.2.
Endometrial Hyperplasia 372 27.3.
Endometrial Carcinoma 373 27.4.
Gestational Trophoblastic Disease 374 27.5.
Retained Products of Conception 377 28
Ovaries and Adnexa 380 28.1.
Simple Ovarian Cysts 380 28.2.
Hemorrhagic Ovarian Cysts 381 28.3.
Ovarian Teratomas 384 28.4.
Ovarian Benign Neoplasms Other Than Teratomas 386 28.5.
Ovarian Cancer 389 28.6.
Ovarian Torsion 391 28.7.
Endometriosis 395 28.8.
Hydrosalpinx 397 28.9.
Tubo-ovarian Abscess 397 29
Ectopic Pregnancy 400 29.1.
Tubal Ectopic Pregnancy 400 29.2.
Cornual (Interstitial) Ectopic Pregnancy 404 29.3.
Cervical Ectopic Pregnancy 406 29.4.
Cesarean Scar Pregnancy Implantation 407 29.5.
Abdominal Ectopic Pregnancy 409 29.6.
Heterotopic Pregnancy 410
Procedures

30 Diagnostic Gynecological Procedures 412 30.1.
Saline Infusion Sonohysterography 412 31
Therapeutic Gynecological Procedures 416 31.1.
Ovarian Cyst Aspiration 416 31.2.
Oocyte Retrieval 418 31.3.
Ultrasound-Guided Uterine Instrumentation Through the Cervix 418 31.4.
Ectopic Pregnancy Ablation 420 31.5.
Pelvic Abscess Drainage 423 Index 425
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