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1272 PART IV Obstetric and Fetal SonographyTABLE 37.1 Congenital Heart Disease and Associated Risk Factors—cont’dFactor Frequency Most Common LesionsKartagenerKlippel-FeilLaurence-Moon (Bardet-Biedl)LeopardMeckel-GruberNoonanPallister-HallPierre RobinPolandRefsumSeckelSmith-Lemli-OpitzTreacher CollinsRubinstein-TaybiSilverShort rib polydactyly (non-Majewski type)Thrombocytopenia absent radius (TAR)VACTERLWaardenburgWeill-MarchesaniWilliamsZellwegerDextrocardiaVSD, TGA, TAPVRVSDPSVSD, ASD, coarctation, PS, PDAPS, VSD, ASD, PDAUnspeciied CHDASDTOF, ASD, PDA, VSDA-V conduction defectsVSD, PDAVSD, PDAVSD, ASD, PDAASD, VSD, PDATOF, VSDTGA, DOLV, DORV, HRH, AVSDASD, TOF, dextrocardiaUnspeciied CHDVSDPS, VSDSupravalvular AS, PS, VSD, ASDVSD, ASD, PDACHROMOSOMALTrisomy 13 (Patau) 90% VSD, ASD, dextroposition, PDATrisomy 18 (Edward) 99% Bicuspid AV, PS, VSD, ASD, PDATrisomy 21 (Down) 50% A-V canal, VSD, ASD, PDATriploidyASD, VSD5p− (cri du chat) 30% Unspeciied CHD9p−VSD, PS, PDAPartial trisomy 10q 50% Unspeciied CHD13q−Unspeciied CHDT 20p syndromesVSD, TOFTurner (45,X) 20% Bicuspid AV, AS, coarctation, VSD, ASD, AVSD8 trisomy (mosaic) 50% VSD, ASD, PDA9 trisomy (mosaic) 50% VSD, coarctation, DORV13 q 25% VSD+14q 50% ASD, TOF, PDA18q 50% VSDXXXXY 14% ASD, ARCA, PDADISEASES AND CONDITIONSCrouzonNeuroibromatosisTuberous sclerosisThalassemia majorCoarctation, PDAPS, coarctationRhabdomyoma, angiomaCardiomyopathyAO, Aorta; ARCA, anomalous right coronary artery; AS, aortic stenosis; ASD, atrial septal defect; AV, aortic valve; A-V, atrioventricular; AVSD,atrioventricular septal defect; CHD, congenital heart disease; DOLV, double-outlet left ventricle; DORV, double-outlet right ventricle; HLHS,hypoplastic left heart syndrome; HRH, hypoplastic right heart; MA, mitral atresia; PA, pulmonary atresia; PDA, patent ductus arteriosus; PS,pulmonary stenosis; TA, tricuspid atresia; TAPVR, total anomalous pulmonary venous return; TGA, transposition of great arteries; TOF, tetralogyof Fallot; truncus, truncus arteriosus; VSD, ventricular septal defect.Data from Lachman RS and Donofrio MT. 45,251
CHAPTER 37 The Fetal Heart 1273TABLE 37.2 Recurrence Risksin Siblings for Any CongenitalHeart Defect aDefectSUGGESTED RISK(%)If OneSiblingIf TwoSiblingsFibroelastosis 4 12Ventricular septal defect 3 10Patent ductus arteriosus 3 10Atrioventricular septal defect 3 10Atrial septal defect 2.5 8Tetralogy of Fallot 2.5 8Pulmonary stenosis 2 6Coarctation of aorta 2 6Aortic stenosis 2 6Hypoplastic left heart 2 6Transposition 1.5 5Tricuspid atresia 1 3Ebstein anomaly 1 3Truncus 1 3Pulmonary atresia 1 3a Combined data published during two decades from European andNorth American populations.With permission from Nora J. 252TABLE 37.3 Suggested OffspringRecurrence Risk (%) for Congenital HeartDefects Given One Affected ParentDefectAFFECTED PARENTFatherMotherAortic stenosis 3 13-18Atrial septal defect 1.5 4-4.5Atrioventricular septal defect 1 14Coarctation of aorta 2 4Pulmonary stenosis 2 4-6.5Tetralogy of Fallot 1.5 2.5Ventricular septal defect 2 6-10With permission from Nora J. 252with literature suggesting a ninefold increase in the incidenceof CHD in monochorionic-diamniotic twin gestations. 19 Lastly,there appears to be a slightly increased risk of CHD with in vitrofertilization (IVF), although at least some of this increased riskappears to be related to the increased incidence of twin pregnanciesassociated with IVF. 20 Most fetuses with CHD have no knownrisk factors, which underscores the importance of a meticulousevaluation of the four-chamber heart views and outlow tractson all routine obstetric ultrasound examinations. When severestructural cardiac anomalies are identiied before viability, terminationmay be ofered. Certainly, one of the most importantaspects of fetal echocardiography is the psychological relief itafords parents whenever normal cardiac anatomy and functionare documented in a fetus at risk.NORMAL FETAL CARDIAC ANATOMYAND SCANNING TECHNIQUEShe fetal heart is similar to that of the adult, with several anatomicand physiologic diferences. he long axis of the fetal heart isperpendicular to the long axis of the body, such that a transversesection through the fetal thorax demonstrates the four cardiacchambers in a single view. he adult heart, in contrast, is obliquelyoriented with its long axis along a line between the let hip andthe right shoulder. he four-chamber view is important because10% to 96% of structural anomalies are detectable on thisview. 21-26Common Indications for FetalEchocardiographyAbnormal heart on routine ultrasoundHydropsPolyhydramniosFetal arrhythmiaFetal chromosomal anomaliesFetal extracardiac anomaliesFamily history (congenital heart disease [CHD], syndromesassociated with CHD)Maternal disease (diabetes, collagen vascular,phenylketonuria)Maternal infection (rubella)Teratogen exposureIncreased nuchal translucency on irst-trimester screeningIn vitro fertilizationMonochorionic twinsMonitoring response to intrauterine therapyMonitoring fetus at risk for decompensation (persistenttachyarrhythmia, hydrops)Cardiac axis and position are normally such that the apex ofthe heart points to the let and the bulk of the heart is in the letside of the chest (Fig. 37.1A). his is levocardia. In mesocardiathe heart is central with the apex pointing anteriorly. In dextrocardiathe apex is directed rightward, and the heart is primarilyin the right side of the chest. his abnormality must be distinguishedfrom dextroposition (Fig. 37.1B), in which the heartmaintains a normal axis but is displaced to the right by an externalprocess, such as a let chest mass or pleural efusion. Abnormalcardiac axis is associated with a 50% mortality and abnormalcardiac position with an 81% mortality. 27he fetal cardiovascular system contains several unique shunts:the ductus venosus, foramen ovale, and ductus arteriosus (Fig.37.2). Antenatally, the placenta rather than the lungs is the fetus’ssole source of oxygen. Oxygenated blood leaves the placentathrough the umbilical vein and travels through the hepaticvasculature and ductus venosus to the inferior vena cava (IVC)and then into the fetal right atrium. As a result of increasedvelocity, blood entering the IVC via the ductus venosus is shunted
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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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ABCDFIG. 33.13 Hypertelorism With E
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ABCDFIG. 33.16 Dacryocystocele. (A)
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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
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CHAPTER 34 The Fetal Brain 1173FIG.
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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
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CHAPTER 34 The Fetal Brain 1181ABCD
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CHAPTER 34 The Fetal Brain 1183asym
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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
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CHAPTER 34 The Fetal Brain 1211Huma
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CHAPTER 34 The Fetal Brain 1213121.
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CHAPTER 34 The Fetal Brain 1215221.
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CHAPTER 35 The Fetal Spine 1217ABCF
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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 and 1442: CHAPTER 36 The Fetal Chest 1269204.
Page 1443: CHAPTER 37 The Fetal Heart 1271TABL
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
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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.
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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
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CHAPTER42Fetal Measurements: Normal
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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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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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ABCFIG. 51.39 Hepatosplenomegaly. W
Page 1945 and 1946:
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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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CHAPTER53The Pediatric Gastrointest
Page 2007 and 2008:
CHAPTER 53 The Pediatric Gastrointe
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CHAPTER 54 Pediatric Pelvic Sonogra
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CHAPTER 55 The Pediatric Hip and Ot
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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:
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Page 2129 and 2130:
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ABCFIG. 56.15 Access for Drainage o
Page 2133 and 2134:
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APPENDIXUltrasound Artifacts: A Vir
Page 2143 and 2144:
APPENDIX Ultrasound Artifacts: A Vi
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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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