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CHAPTER37The Fetal HeartElizabeth R. Stamm and Julia A. DroseSUMMARY OF KEY POINTS• Moderate to severe congenital heart disease (CHD) occursin approximately 6 per 1000 live births.• The incidence of CHD is much higher in the fetalpopulation, estimated to be at least 15 per 1000.• The incidence of CHD is higher with positive familyhistory, monochorionic twins, and in vitrofertilization.• Most fetuses with CHD have no known risk factors.• Fetal echocardiography is a safe and effective method ofdetecting CHD.• Early detection of CHD may have a substantial impact oncare and prognosis, allowing intrauterine therapy, carefullyplanned delivery, and parental counseling.• Advancements in surgical techniques and perioperativemanagement have signiicantly improved prognosis inmany cases.CHAPTER OUTLINENORMAL FETAL CARDIACANATOMY AND SCANNINGTECHNIQUESSTRUCTURAL ANOMALIESAtrial Septal DefectVentricular Septal DefectAtrioventricular Septal DefectEbstein AnomalyHypoplastic Right VentricleHypoplastic Left Heart SyndromeUniventricular HeartTetralogy of FallotTruncus ArteriosusDouble-Outlet Right VentricleTransposition of Great ArteriesAnomalous Pulmonary Venous ReturnCoarctation of AortaAortic StenosisPulmonic StenosisCardiosplenic SyndromesCardiac TumorsCardiomyopathyEctopia CordisARRHYTHMIASPremature Atrial and VentricularContractionsTachycardiaBradycardiaCongenital Heart BlockSonographic evaluation of the fetal heart can identify cardiacabnormalities that afect obstetric care in a variety of ways,including mode of delivery, location of delivery, intrauterinetherapy, parental reassurance, and opportunity for termination.Congenital heart disease (CHD) is a signiicant problem, withan incidence of moderate and severe CHD of approximately 6per 1000 live births. If trivial lesions such as tiny muscularventricular septal defects (VSDs) are included, the incidenceis as high as 75 per 1000 live births. 1 It is more diicult todetermine the exact incidence of CHD in the fetal population.One large study suggested that CHD occurs in at least 15 per1000 fetuses. 2 More than 20% of perinatal deaths caused bycongenital malformations are the result of a congenital heartdefect. 3 In 85% of CHD cases, both environmental and geneticfactors are involved (Table 37.1). 4-7 he remaining 15% of cardiacanomalies are associated with a single gene or chromosomalabnormality. 5 he risk of CHD increases to 2% to 3% with anafected sibling and to approximately 10% with two afectedsiblings or an afected mother—although the incidence is variabledepending on the type of CHD in the afected relative. 5,8 herisk to ofspring of afected mothers is substantially higher thanfor those with afected fathers, suggesting that cytoplasmicinheritance may play a role in the genetics of CHD (Tables 37.2and 37.3). Only 50% of recurrent heart lesions are of the sametype as the previously diagnosed defect. 9Extracardiac malformations occur in 25%, 10 and chromosomalanomalies occur in 13% of live-born neonates withCHD. 11-13 About 50% of fetuses with nonimmune hydrops andcardiac anomalies have a chromosomal anomaly, and 10% willhave extracardiac anomalies. 14 Hydrops in the setting of CHDis predictive of a very poor prognosis.Although the most common indications for formal fetalechocardiography are family history of CHD and fetal arrhythmia,the majority of these fetuses will have normal hearts. hehighest incidence of CHD occurs in patients referred becauseof an abnormal four-chamber view, fetal hydrops, or signiicantpolyhydramnios on a routine obstetric ultrasound. 15,16 A routineultrasound examination with a suspected fetal cardiac anomalyis associated with a 50% to 69% risk of CHD in live-borninfants. 17,18 Monochorionic twins are at a higher risk for CHD,1270
CHAPTER 37 The Fetal Heart 1271TABLE 37.1 Congenital Heart Disease and Associated Risk FactorsFactor Frequency Most Common LesionsMATERNAL CONDITIONSDiabetes 3%-5% TGA, VSD, coarctationLupus erythematosus (1%-5%) Heart blockPhenylketonuria (12%-14%) TOF, VSD, ASD, coarctationInfectionCardiomyopathyRubella (1%-2%) TOF, PS, VSD, ASD, PDA, cardiomegalyDRUGSAccutane (retinoic acid) 8%-20% Truncus, TGA, TOF, DORV, VSD, AO arch interruption,or hypoplasiaAlcohol 25%-30% VSD, ASD, PDA, DORV, PA, TOF, dextrocardiaAmantadineSingle vent with PAAmphetamines 5%-10% VSD, TGA, PDAAzathioprinePSCarbamazepineASD, PDAChlordiazepoxideUnspeciied CHDCodeineUnspeciied CHDCortisoneVSD, coarctationCoumadinUnspeciied CHDCyclophosphamideTOFCytarabineTOFDaunorubicinTOFDextroamphetamineASDDiazepamUnspeciied CHDDilantin (hydantoin)AS, VSD, ASD, coarctationLithium <2% Ebstein anomaly, TA, ASD, dextrocardia, MAMethotrexateDextrocardiaOral contraceptivesUnspeciied CHDParamethadioneTOFPenicillamineVSDPrimidoneVSDProgesteroneTOF, truncus, VSDQuinineUnspeciied CHDThalidomide 5%-10% TOF, VSD, ASD, truncusTriluoperazineTGATrimethadione 15%-30% ASD, VSD, TGA, TOF, HLHS, AS, PSValproic acidTOF, coarctation, HLHS, AS, ASD, VSD, interruptedAO arch, PA without VSDWarfarin (Coumadin)Unspeciied CHDSYNDROMESApertVSD, coarctation, TOFArthrogryposis multiplex congenitaVSD, coarctation, AS, PDAAtrial myxoma, familialMyxomaBeckwith-WiedemannCardiomegalyC syndrome (Opitz trigonocephaly)PDACarpenterVSD, PS, TGA, PDACat’s eye (22 partial trisomy) 40% TAPVR, VSD, ASDCHARGEVSD, ASDCHILDVSD, ASDConradi-Hünermann (chondrodysplasia punctata)VSD, PDAde Lange 29% VSD, TOF, DORV, PDADiGeorgeVSD, coarctation, truncusEllis–van Creveld (chondroectodermal dysplasia) 50% ASD, single atriumFanconi pancytopeniaASD, PDAGoldenharTOF, VSD, ASDHolt-OramASD, VSDContinued
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viiiContributorsOlga R. Brook, MDAs
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xContributorsChristy K. Holland, Ph
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xiiContributorsRupa Radhakrishnan,
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xxiiContentsVOLUME IIPART IV Obstet
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xxivVideo ContentsVideo 12.8 Angiog
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xxviVideo ContentsVideo 26.20 High-
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xxviiiVideo Contents42 Fetal Measur
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2 PART I Physicsphysics. he amplitu
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4 PART I Physics× ms×FIG. 1.4 Ult
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6 PART I Physicsθ 1 = 20°Tissue A
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8 PART I Physicssignature. Broad-ba
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10 PART I PhysicsFIG. 1.13 B-Mode I
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12 PART I PhysicsIn these transduce
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14 PART I PhysicsFIG. 1.17 Tissue H
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16 PART I PhysicsKey Points of Ultr
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18 PART I PhysicsA - Normal liverv
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20 PART I PhysicsFIG. 1.27 Reverber
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22 PART I Physics-0 dBUncorrected-0
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24 PART I Physicsθ = 0°cos θ = 1
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26 PART I PhysicsABFIG. 1.38 Color
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28 PART I PhysicsChanges in Doppler
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30 PART I PhysicsABFIG. 1.44 Wall F
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32 PART I PhysicsABCDFIG. 1.46 Alia
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CHAPTER2Biologic Effects and Safety
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36 PART I PhysicsPressurePulse repe
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38 PART I PhysicsUltrasound imaging
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40 PART I Physicsacoustic power and
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42 PART I PhysicsFIG. 2.6 Acoustic
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44 PART I PhysicsThe AIUM Statement
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46 PART I Physics1. Current ultraso
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48 PART I PhysicsEPIDEMIOLOGYWith a
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50 PART I Physicscontrols whether t
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52 PART I Physics70. Hwang JH, Tu J
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54 PART I PhysicsA B 5 μmFIG. 3.1
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56 PART I Physicsstudies with Levov
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58 PART I Physicsabdominal organs.
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60 PART I PhysicsHarmonic B-Mode Im
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62 PART I PhysicsFIG. 3.9 Contrast-
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64 PART I Physicsdramatic manifesta
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66 PART I Physics5 µmFIG. 3.15 Fra
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68 PART I Physicsplatelet lysis), n
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70 PART I PhysicsEnhancement1 2 3 4
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72 PART I Physics46. Hamilton MF, B
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PART TWO: Abdominal and Pelvic Sono
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76 PART II Abdominal and Pelvic Son
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100 PART II Abdominal and Pelvic So
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ABFIG. 5.20 Microabscesses in Two P
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ABFIG. 6.32 Distal Cholangiocarcino
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CHAPTER7The PancreasThomas Winter a
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CHAPTER8The Gastrointestinal TractS
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ABFIG. 8.16 Lymphadenopathy in Two
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A B CD E FG H IFIG. 8.23 Inlammator
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FIG. 8.56 Gastrointestinal Stromal
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CHAPTER9The Kidney and Urinary Trac
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Remnant ofpronephrosMesonephrosBMes
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CHAPTER11The Adrenal GlandsChristin
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CHAPTER12The RetroperitoneumRaymond
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CHAPTER13Dynamic Ultrasound of Hern
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CHAPTER14The PeritoneumAnthony E. H
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CHAPTER15The UterusDouglas Brown an
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CHAPTER16The AdnexaRochelle Filker
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692 PART III Small Parts, Carotid A
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CHAPTER20The Parathyroid GlandsBonn
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*** *FIG. 21.8 Terminal Ductolobula
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CHAPTER22The ScrotumDaniel Sommers
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CHAPTER23Overview of Musculoskeleta
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CHAPTER25Musculoskeletal Interventi
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ABCDFIG. 25.15 Biceps Tendon Sheath
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CHAPTER27Peripheral VesselsMark E.
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ABFIG. 27.29 Chronic Deep Venous Th
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1000 PART III Small Parts, Carotid
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e2APPENDIXUltrasound Artifacts: A V
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FIG. A.18 Comet-Tail Artifact. On c
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e12APPENDIXUltrasound Artifacts: A
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I-2 IndexAcetabulumdescription of,
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I-4 IndexAnemiafetal, hydrops from,
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I-6 IndexAttenuationcoeicient, 36of
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I-8 IndexBlood low. See also Cerebr
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I-10 IndexBreast(s) (Continued)thic
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I-12 IndexCat-scratch disease, pedi
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I-14 IndexChorion laeve, 1465-1466C
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I-16 IndexContrast agents (Continue
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I-18 IndexCyst(s) (Continued) Cyst(
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I-20 IndexDoppler ultrasound (Conti
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I-22 IndexEndocardial cushion(s), 1
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I-24 IndexFibroma(s) (Continued)par
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I-26 IndexGerminal epithelium, 565G
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I-28 IndexHematoma(s) (Continued)pe
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I-30 IndexHoloprosencephaly (HPE) (
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I-32 IndexImplants, breast (Continu
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I-34 IndexJaundice (Continued)bile
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I-36 IndexLipomyelocele, closed spi
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I-38 IndexMammary ductsnormal sonog
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I-40 IndexMolar pregnancy. See Hyda
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I-42 IndexNonrhizomelic chondrodysp
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I-44 IndexPancreas (Continued)percu
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I-46 IndexPeritoneum (Continued)tum
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I-48 IndexPosterior fossa (Continue
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I-50 IndexPyloric musclehypertrophy
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I-52 IndexSample volume size, Doppl
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I-54 IndexSpectral broadening, in D
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I-56 IndexSuperoanteromedial ridge,
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I-58 Indexhrombosis (Continued)of s
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I-60 IndexTrisomy 18 (Edwards syndr
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I-62 IndexUrinary tract, pediatric
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I-64 IndexWalker-Warburg syndromeco
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DIAGNOSTICULTRASOUND
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DIAGNOSTICULTRASOUND5TH EDITIONCARO
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ABOUT THE EDITORSCarol M. Rumack, M
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ContributorsviiCONTRIBUTORSJacques
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ContributorsixPeter M. Doubilet, MD
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ContributorsxiAna P. Lourenco, MDAs
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ContributorsxiiiWendy hurston, MDAs
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In memory of my parents, Drs. Ruth
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PrefacexviiPREFACEhe ith edition of
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AcknowledgmentsxixACKNOWLEDGMENTSWe
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ContentsxxiCONTENTSVOLUME IPART I P
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Video ContentsxxiiiVIDEO CONTENTS4
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Video Contentsxxv19 The Thyroid Gla
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Video Contentsxxvii33 The Fetal Fac
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Video Contentsxxix52 The Pediatric
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DIAGNOSTICULTRASOUND
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PART FOUR: Obstetric and Fetal Sono
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CHAPTER 28 Overview of Obstetric Im
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ABCDFIG. 28.9 Second-Trimester Biom
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CHAPTER 29 Bioeffects and Safety of
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CHAPTER 30 The First Trimester 1049
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CHAPTER 31 Chromosomal Abnormalitie
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ABCDFIG. 31.12 Sonographic Findings
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CHAPTER32Multifetal PregnancyMary C
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CHAPTER 32 Multifetal Pregnancy 111
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ABFIG. 32.5 Sonographic Findings Se
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CHAPTER33The Fetal Face and NeckAna
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CHAPTER 33 The Fetal Face and Neck
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Page 1313 and 1314:
Page 1315 and 1316:
Page 1317 and 1318:
ABCDFIG. 33.13 Hypertelorism With E
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ABCDFIG. 33.16 Dacryocystocele. (A)
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Page 1325 and 1326:
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ABCDEFFIG. 33.24 Unilateral Complet
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CHAPTER 34 The Fetal Brain 1167impo
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CHAPTER 34 The Fetal Brain 1169cmAB
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CingulatePOCalcarineAB21 wkCD25 wkI
Page 1345 and 1346:
CHAPTER 34 The Fetal Brain 1173FIG.
Page 1347 and 1348:
CHAPTER 34 The Fetal Brain 1175LTAR
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CHAPTER 34 The Fetal Brain 1177CC12
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CHAPTER 34 The Fetal Brain 1179SPEC
Page 1353 and 1354:
CHAPTER 34 The Fetal Brain 1181ABCD
Page 1355 and 1356:
CHAPTER 34 The Fetal Brain 1183asym
Page 1357 and 1358:
CHAPTER 34 The Fetal Brain 1185FIG.
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CHAPTER 34 The Fetal Brain 1187Cere
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CHAPTER 34 The Fetal Brain 1189loba
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CHAPTER 34 The Fetal Brain 1191ABCF
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CHAPTER 34 The Fetal Brain 1193ABCF
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CHAPTER 34 The Fetal Brain 1195spor
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ABCCCDEFFIG. 34.24 Type 2 Lissencep
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CHAPTER 34 The Fetal Brain 1199ABFI
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CHAPTER 34 The Fetal Brain 120120 w
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CHAPTER 34 The Fetal Brain 1203Ultr
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CHAPTER 34 The Fetal Brain 1205ABCD
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VSSABHHPHCDEFFIG. 34.35 Intracrania
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CHAPTER 34 The Fetal Brain 1209VABC
Page 1383 and 1384:
CHAPTER 34 The Fetal Brain 1211Huma
Page 1385 and 1386:
CHAPTER 34 The Fetal Brain 1213121.
Page 1387 and 1388:
CHAPTER 34 The Fetal Brain 1215221.
Page 1389 and 1390:
CHAPTER 35 The Fetal Spine 1217ABCF
Page 1391 and 1392: CHAPTER 35 The Fetal Spine 1219L1S3
Page 1393 and 1394: CHAPTER 35 The Fetal Spine 1221FTFT
Page 1395 and 1396: CHAPTER 35 The Fetal Spine 1223FIG.
Page 1397 and 1398: CHAPTER 35 The Fetal Spine 1225TABL
Page 1399 and 1400: CHAPTER 35 The Fetal Spine 1227Feta
Page 1401 and 1402: CHAPTER 35 The Fetal Spine 1229MMAB
Page 1403 and 1404: ABCDEFFIG. 35.15 Skin-Covered Myelo
Page 1405 and 1406: CHAPTER 35 The Fetal Spine 1233diic
Page 1407 and 1408: CHAPTER 35 The Fetal Spine 1235CCSC
Page 1409 and 1410: CHAPTER 35 The Fetal Spine 1237chon
Page 1411 and 1412: CHAPTER 35 The Fetal Spine 1239BSCT
Page 1413 and 1414: CHAPTER 35 The Fetal Spine 124162.
Page 1415 and 1416: CHAPTER36The Fetal ChestDorothy Bul
Page 1417 and 1418: CHAPTER 36 The Fetal Chest 1245seco
Page 1419 and 1420: CHAPTER 36 The Fetal Chest 1247TABL
Page 1421 and 1422: CHAPTER 36 The Fetal Chest 1249Left
Page 1423 and 1424: CHAPTER 36 The Fetal Chest 12511ABC
Page 1425 and 1426: CHAPTER 36 The Fetal Chest 1253ABCF
Page 1427 and 1428: CHAPTER 36 The Fetal Chest 1255cent
Page 1429 and 1430: CHAPTER 36 The Fetal Chest 1257Left
Page 1431 and 1432: CHAPTER 36 The Fetal Chest 1259ABCD
Page 1433 and 1434: CHAPTER 36 The Fetal Chest 1261RTLT
Page 1435 and 1436: CHAPTER 36 The Fetal Chest 1263ARig
Page 1437 and 1438: CHAPTER 36 The Fetal Chest 12659. B
Page 1439 and 1440: CHAPTER 36 The Fetal Chest 1267107.
Page 1441: CHAPTER 36 The Fetal Chest 1269204.
Page 1445 and 1446: CHAPTER 37 The Fetal Heart 1273TABL
Page 1447 and 1448: CHAPTER 37 The Fetal Heart 1275Plac
Page 1449 and 1450: CHAPTER 37 The Fetal Heart 1277ADop
Page 1451 and 1452: CHAPTER 37 The Fetal Heart 1279LVRV
Page 1453 and 1454: CHAPTER 37 The Fetal Heart 1281RARV
Page 1455 and 1456: CHAPTER 37 The Fetal Heart 1283RARV
Page 1457 and 1458: CHAPTER 37 The Fetal Heart 1285Norm
Page 1459 and 1460: CHAPTER 37 The Fetal Heart 1287RVLV
Page 1461 and 1462: CHAPTER 37 The Fetal Heart 1289RVTA
Page 1463 and 1464: CHAPTER 37 The Fetal Heart 1291LVRA
Page 1465 and 1466: CHAPTER 37 The Fetal Heart 1293Aspl
Page 1467 and 1468: CHAPTER 37 The Fetal Heart 1295PLVL
Page 1469 and 1470: CHAPTER 37 The Fetal Heart 1297HR-L
Page 1471 and 1472: CHAPTER 37 The Fetal Heart 129951.
Page 1477 and 1478: CHAPTER 38 The Fetal Gastrointestin
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CHAPTER 38 The Fetal Gastrointestin
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UrogenitalsinusMesonephrosMesonephr
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CHAPTER 39 The Fetal Urogenital Tra
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CHAPTER 40 The Fetal Musculoskeleta
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CHAPTER 41 Fetal Hydrops 1413ABFIG.
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ABCDFIG. 41.2 Ascites. (A) Fluid ou
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CHAPTER 41 Fetal Hydrops 1417A B CD
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CHAPTER 41 Fetal Hydrops 1423later
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CHAPTER 41 Fetal Hydrops 1427CHABCH
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CHAPTER 41 Fetal Hydrops 1429Monoch
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CHAPTER 41 Fetal Hydrops 1431feedin
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CHAPTER 41 Fetal Hydrops 1433TABLE
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CHAPTER 41 Fetal Hydrops 1435sampli
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CHAPTER 41 Fetal Hydrops 1437Predel
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CHAPTER 41 Fetal Hydrops 143973. Ma
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CHAPTER 41 Fetal Hydrops 1441169. I
Page 1615 and 1616:
CHAPTER42Fetal Measurements: Normal
Page 1617 and 1618:
CHAPTER 42 Fetal Measurements 1445F
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CHAPTER 42 Fetal Measurements 1447T
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CHAPTER 42 Fetal Measurements 1451p
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CHAPTER 42 Fetal Measurements 1453d
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CHAPTER 42 Fetal Measurements 1455A
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CHAPTER 42 Fetal Measurements 1459A
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CHAPTER 42 Fetal Measurements 14618
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CHAPTER 42 Fetal Measurements 14631
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CHAPTER43Sonographic Evaluation oft
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CHAPTER 43 Sonographic Evaluation o
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CHAPTER44Cervical Ultrasound and Pr
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CHAPTER 44 Cervical Ultrasound and
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PART FIVE: Pediatric SonographyCHAP
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CHAPTER 45 Neonatal and Infant Brai
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CHAPTER46Duplex Sonography of the N
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CHAPTER 46 Duplex Sonography of the
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CHAPTER47Doppler Sonography of the
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CHAPTER 47 Doppler Sonography of th
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CHAPTER 48 The Pediatric Head and N
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CHAPTER 49 The Pediatric Spinal Can
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Page 1865 and 1866:
RA B CDEFGFIG. 49.27 Neuroblastoma
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CHAPTER50The Pediatric ChestChetan
Page 1875 and 1876:
CHAPTER 50 The Pediatric Chest 1703
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CHAPTER 51 The Pediatric Liver and
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Page 1939 and 1940:
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Page 1943 and 1944:
ABCFIG. 51.39 Hepatosplenomegaly. W
Page 1945 and 1946:
Page 1947 and 1948:
CHAPTER52The Pediatric Urinary Trac
Page 1949 and 1950:
CHAPTER 52 The Pediatric Urinary Tr
Page 1951 and 1952:
TABLE 52.4 Mean Total Renal Volumes
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Page 2003 and 2004:
Page 2005 and 2006:
CHAPTER53The Pediatric Gastrointest
Page 2007 and 2008:
CHAPTER 53 The Pediatric Gastrointe
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Page 2013 and 2014:
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Page 2017 and 2018:
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CHAPTER 54 Pediatric Pelvic Sonogra
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Page 2091 and 2092:
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CHAPTER 55 The Pediatric Hip and Ot
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Page 2097 and 2098:
Page 2099 and 2100:
Page 2101 and 2102:
Page 2103 and 2104:
Page 2105 and 2106:
Page 2107 and 2108:
Page 2109 and 2110:
ABCDFIG. 55.13 Normal and Dislocate
Page 2111 and 2112:
Page 2113 and 2114:
Page 2115 and 2116:
CHAPTER 56 Pediatric Interventional
Page 2117 and 2118:
Page 2119 and 2120:
Page 2121 and 2122:
Page 2123 and 2124:
Page 2125 and 2126:
Page 2127 and 2128:
Page 2129 and 2130:
Page 2131 and 2132:
ABCFIG. 56.15 Access for Drainage o
Page 2133 and 2134:
Page 2135 and 2136:
Page 2137 and 2138:
Page 2139 and 2140:
Page 2141 and 2142:
APPENDIXUltrasound Artifacts: A Vir
Page 2143 and 2144:
APPENDIX Ultrasound Artifacts: A Vi
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Page 2173 and 2174:
Page 2175 and 2176:
Page 2177 and 2178:
Page 2179 and 2180:
IndexAAA anastomoses. See Arterial/
Page 2181 and 2182:
Index I-3Adnexa (Continued)transvag
Page 2183 and 2184:
Index I-5Arrays, transducer, 11-12A
Page 2185 and 2186:
Index I-7Bioefects (Continued) Biop
Page 2187 and 2188:
Index I-9Brain, neonatal/infant (Co
Page 2189 and 2190:
Index I-11Carcinoma(s) (Continued)
Page 2191 and 2192:
Index I-13Cervix (Continued)for sym
Page 2193 and 2194:
Index I-15Color Doppler ultrasound
Page 2195 and 2196:
Index I-17Cystic artery, 194promine
Page 2197 and 2198:
Index I-19Diabetes mellituschronic
Page 2199 and 2200:
Index I-21Echinococcal disease (Con
Page 2201 and 2202:
Index I-23Exudate ascites, 506-507E
Page 2203 and 2204:
Index I-25Gallbladder (Continued)ad
Page 2205 and 2206:
Index I-27Gyriabnormalities of, in
Page 2207 and 2208:
Index I-29Hernia(s). See also Diaph
Page 2209 and 2210:
Index I-31Hyperechoic tissue, in br
Page 2211 and 2212:
Index I-33Internal jugular vein (IJ
Page 2213 and 2214:
Index I-35Kidneys, pediatric (Conti
Page 2215 and 2216:
Index I-37Liver transplantation (Co
Page 2217 and 2218:
Index I-39Mesentery, small bowel, 5
Page 2219 and 2220:
Index I-41Nasal bone, fetal (Contin
Page 2221 and 2222:
Index I-43Orbits, fetal (Continued)
Page 2223 and 2224:
Index I-45Patau syndrome. See Triso
Page 2225 and 2226:
Index I-47Pleural efusionsfetal, 12
Page 2227 and 2228:
Index I-49Prostate (Continued)thera
Page 2229 and 2230:
Index I-51Renal transplantation (Co
Page 2231 and 2232:
Index I-53Shunt(s) (Continued) Skel
Page 2233 and 2234:
Index I-55Splenic vein (Continued)t
Page 2235 and 2236:
Index I-57Testis(es) (Continued)cys
Page 2237 and 2238:
Index I-59Transcranial Doppler (TCD
Page 2239 and 2240:
Index I-61Umbilical cord, 1481-1487
Page 2241 and 2242:
Index I-63Vein of Galen (Continued)
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Page 2249:
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