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1960 PART V Pediatric Sonography*AFB** ****Transverse RT lower quadrantCDRightRightEFIG. 56.17 Drainage of PostoperativeAppendix Abscess Due to Retained Fecalith.(A) Retained echogenic fecalith (*) inthe right lower quadrant. (B) Computedtomography scan showing identical area. Blackarrow indicates the path of the subsequentultrasound-guided access. (C) Initial ultrasoundguidedneedle (black arrows) access to theperi-fecalith abscess (black *). White arrowsindicate the anterior surface of the fecalith.(D) Fluoroscopy with contrast showing thesheath (black arrows) adjacent to the fecalith(white *). (E) Fluoroscopy images of an intervalimage-guided procedure showing capture ofthe fecalith (black arrow) within the accesssheath (white arrows) and subsequent fecalithremoval through the sheath.
CHAPTER 56 Pediatric Interventional Sonography 1961Targeted Organ Lesion BiopsyUltrasound-guided nontarget-organ biopsy such as for suspectedliver or kidney abnormality is a well-established procedure.Targeted intraorgan lesion biopsy is more demanding. Each casemust be assessed on its merits, but caution should be exercisedfor lesions close to the diaphragm or major intraorgan orextraorgan vasculature. Figs. 56.18 and 56.19 illustrate two suchtargeted lesion biopsies.Musculoskeletal ProceduresWhereas CT or cone-beam CT is the usual guidance modalityfor deep bone procedures, ultrasound can be useful for certainperiosteal or cartilage-related lesions (see Fig. 56.1; Fig. 56.20,Video 56.5, Video 56.6, and Video 56.7).Steroid injection for local treatment of speciic joints in diseasessuch as juvenile rheumatoid arthritis can be achieved bynonimage-guided access in large joints such as the knee, butincreasingly, rheumatologists are referring patients for imageguidedsteroid injection for smaller or technically diicultjoints such as the subtalar, temporomandibular, or interphalangealjoints. Ultrasound guidance can be used for accurate accessto these small joints. 28,29 Ultrasound-guided steroid injectionof tendon sheaths is a valuable procedure (Fig. 56.21,Video 56.8).Some deep foreign bodies can be removed underultrasound guidance (Fig. 56.22). It is important that theultrasound-guided procedure be done before the wound isopened and probed in the emergency room or operatingroom. Otherwise, air degrades the ability of ultrasound tovisualize the foreign body and the case must be cancelled andrescheduled.Head and Neck LesionsCertain vascular and lymphatic malformations are amenable toultrasound-guided access and treatment, usually by sclerosingagents. 30 Orbital lymphatic malformations are diicult to treatsurgically but respond well to percutaneous ultrasound-guidedsclerosis (Fig. 56.23).Ranulas are rare lesions consisting of saliva-containing cystsmost commonly due to trauma or obstruction of the sublingualduct. he sublingual duct secretes saliva continuously, whereasthe submandibular and parotid duct secrete only with oral stimulisuch as eating, and therefore the sublingual gland is more proneto formation of ranula. Plunging ranula can be treated successfullyby ultrasound and luoroscopically guided sclerosis (Fig. 56.24).NOTE FROM THE AUTHORShe authors dedicate this chapter to the memory of Dr. William(Bill) Shiels. Dr. Shiels was an interventional ultrasound innovator,an extreme enthusiast, and co-author of this chapter in the fourthedition. He pioneered many new and innovative techniques inpediatric interventional radiology, oten involving ultrasoundguidance and monitoring. He established a popular system oftraining phantoms and established and maintained active leadershipof the annual “hands-on” sessions at the RSNA for manyyears. He inspired many young pediatric interventionalists andtaught us all. He will be remembered by all who came into contactwith this unique and inspiring person. hank you, Bill.LTLT* * * ****A***B**FIG. 56.18 Targeted Left Upper-Pole Renal Lesion Biopsy in a Patient With Secondary Renal Cell Carcinoma After Prior Treatment forCerebral Primitive Neuroectodermal Tumor. (A) Lesion high in the upper pole of the left kidney (white arrows). Measurement calipers are estimatingthe depth of the biopsy in order to avoid puncturing the adjacent diaphragm (white *) and spleen. Black * indicate posterior margin of kidney. (B)Biopsy device (black arrows) passing through the lesion (white arrows), stopping short of the diaphragm. White * indicate upper pole of kidney.
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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
Page 1343 and 1344:
CingulatePOCalcarineAB21 wkCD25 wkI
Page 1345 and 1346:
CHAPTER 34 The Fetal Brain 1173FIG.
Page 1347 and 1348:
CHAPTER 34 The Fetal Brain 1175LTAR
Page 1349 and 1350:
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
Page 1355 and 1356:
CHAPTER 34 The Fetal Brain 1183asym
Page 1357 and 1358:
CHAPTER 34 The Fetal Brain 1185FIG.
Page 1359 and 1360:
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
Page 1369 and 1370:
ABCCCDEFFIG. 34.24 Type 2 Lissencep
Page 1371 and 1372:
CHAPTER 34 The Fetal Brain 1199ABFI
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CHAPTER 34 The Fetal Brain 120120 w
Page 1375 and 1376:
CHAPTER 34 The Fetal Brain 1203Ultr
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CHAPTER 34 The Fetal Brain 1205ABCD
Page 1379 and 1380:
VSSABHHPHCDEFFIG. 34.35 Intracrania
Page 1381 and 1382:
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
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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
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CHAPTER 36 The Fetal Chest 1261RTLT
Page 1435 and 1436:
CHAPTER 36 The Fetal Chest 1263ARig
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CHAPTER 36 The Fetal Chest 12659. B
Page 1439 and 1440:
CHAPTER 36 The Fetal Chest 1267107.
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CHAPTER 36 The Fetal Chest 1269204.
Page 1443 and 1444:
CHAPTER 37 The Fetal Heart 1271TABL
Page 1445 and 1446:
CHAPTER 37 The Fetal Heart 1273TABL
Page 1447 and 1448:
CHAPTER 37 The Fetal Heart 1275Plac
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CHAPTER 37 The Fetal Heart 1277ADop
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CHAPTER 37 The Fetal Heart 1279LVRV
Page 1453 and 1454:
CHAPTER 37 The Fetal Heart 1281RARV
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CHAPTER 37 The Fetal Heart 1283RARV
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CHAPTER 37 The Fetal Heart 1285Norm
Page 1459 and 1460:
CHAPTER 37 The Fetal Heart 1287RVLV
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CHAPTER 37 The Fetal Heart 1289RVTA
Page 1463 and 1464:
CHAPTER 37 The Fetal Heart 1291LVRA
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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 1473 and 1474:
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Page 1477 and 1478:
CHAPTER 38 The Fetal Gastrointestin
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UrogenitalsinusMesonephrosMesonephr
Page 1511 and 1512:
CHAPTER 39 The Fetal Urogenital Tra
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CHAPTER 40 The Fetal Musculoskeleta
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CHAPTER 41 Fetal Hydrops 1413ABFIG.
Page 1587 and 1588:
ABCDFIG. 41.2 Ascites. (A) Fluid ou
Page 1589 and 1590:
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
Page 1605 and 1606:
CHAPTER 41 Fetal Hydrops 1433TABLE
Page 1607 and 1608:
CHAPTER 41 Fetal Hydrops 1435sampli
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CHAPTER 41 Fetal Hydrops 1437Predel
Page 1611 and 1612:
CHAPTER 41 Fetal Hydrops 143973. Ma
Page 1613 and 1614:
CHAPTER 41 Fetal Hydrops 1441169. I
Page 1615 and 1616:
CHAPTER42Fetal Measurements: Normal
Page 1617 and 1618:
CHAPTER 42 Fetal Measurements 1445F
Page 1619 and 1620:
CHAPTER 42 Fetal Measurements 1447T
Page 1621 and 1622:
Page 1623 and 1624:
CHAPTER 42 Fetal Measurements 1451p
Page 1625 and 1626:
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
Page 1635 and 1636:
CHAPTER 42 Fetal Measurements 14631
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CHAPTER43Sonographic Evaluation oft
Page 1639 and 1640:
CHAPTER 43 Sonographic Evaluation o
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CHAPTER44Cervical Ultrasound and Pr
Page 1669 and 1670:
CHAPTER 44 Cervical Ultrasound and
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Page 1683 and 1684:
PART FIVE: Pediatric SonographyCHAP
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CHAPTER 45 Neonatal and Infant Brai
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CHAPTER46Duplex Sonography of the N
Page 1747 and 1748:
CHAPTER 46 Duplex Sonography of the
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Page 1759 and 1760:
Page 1761 and 1762:
Page 1763 and 1764:
CHAPTER47Doppler Sonography of the
Page 1765 and 1766:
CHAPTER 47 Doppler Sonography of th
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Page 1797 and 1798:
Page 1799 and 1800:
Page 1801 and 1802:
CHAPTER 48 The Pediatric Head and N
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Page 1813 and 1814:
Page 1815 and 1816:
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CHAPTER 49 The Pediatric Spinal Can
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Page 1863 and 1864:
Page 1865 and 1866:
RA B CDEFGFIG. 49.27 Neuroblastoma
Page 1867 and 1868:
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Page 1873 and 1874:
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 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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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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Page 2079 and 2080:
Page 2081 and 2082: CHAPTER 54 Pediatric Pelvic Sonogra
Page 2093 and 2094: CHAPTER 55 The Pediatric Hip and Ot
Page 2109 and 2110: ABCDFIG. 55.13 Normal and Dislocate
Page 2115 and 2116: CHAPTER 56 Pediatric Interventional
Page 2131: ABCFIG. 56.15 Access for Drainage o
Page 2141 and 2142: APPENDIXUltrasound Artifacts: A Vir
Page 2143 and 2144: APPENDIX Ultrasound Artifacts: A Vi
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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