Additional Information
Book Details
Abstract
Now fully updated with more than 2,000 new images and new content throughout, Diagnostic Ultrasound, 5th Edition, by Drs. Carol M. Rumack and Deborah Levine, remains the most comprehensive and authoritative ultrasound resource available. Spanning a wide range of medical specialties and practice settings, it provides complete, detailed information on the latest techniques for ultrasound imaging of the whole body; image-guided procedures; fetal, obstetric, and pediatric imaging; and much more. Up-to-date guidance from experts in the field keep you abreast of expanding applications of this versatile imaging modality and help you understand the "how" and "why" of ultrasound use and interpretation.
- Covers all aspects of diagnostic ultrasound with sections for Physics; Abdominal, Pelvic, Small Parts, Vascular, Obstetric, and Pediatric Sonography.
- Uses a straightforward writing style and extensive image panels with correlative findings.
- Features 5,000 images – more than 2,000 brand-new – including new 2D and 3D imaging as well as the use of contrast agents and elastography.
- Includes a new virtual chapter on artifacts with individually labelled images from throughout the book, displaying artifacts with descriptive legends by category and how they can be used in diagnosis or corrected for better quality imaging.
- Features more images and new uses for contrast agents in the liver, breast, and in pediatric applications. Includes current information on imaging more diagnostic dilemmas, such as Zika virus in the fetus and newborn.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| 9780323529631v1_WEB.pdf | 1 | ||
| Front Cover | 1 | ||
| Inside Front Cover | 2 | ||
| Diagnostic Ultrasound, 2-Volume Set | 3 | ||
| Copyright Page | 6 | ||
| About the Editors | 7 | ||
| Contributors | 9 | ||
| Dedication | 17 | ||
| Preface | 19 | ||
| Acknowledgments | 21 | ||
| Table Of Contents | 23 | ||
| Video Contents | 25 | ||
| I Physics | 35 | ||
| 1 Physics of Ultrasound | 35 | ||
| Chapter Outline | 35 | ||
| Summary of Key Points | 35 | ||
| Basic Acoustics | 36 | ||
| Wavelength and Frequency | 36 | ||
| Propagation of Sound | 36 | ||
| Distance Measurement | 37 | ||
| Acoustic Impedance | 37 | ||
| Reflection | 38 | ||
| Refraction | 39 | ||
| Attenuation | 39 | ||
| Instrumentation | 41 | ||
| Transmitter | 41 | ||
| Transducer | 41 | ||
| Receiver | 42 | ||
| Image Display | 43 | ||
| Mechanical Sector Scanners | 45 | ||
| Arrays | 45 | ||
| Linear Arrays | 45 | ||
| Curved Arrays | 46 | ||
| Phased Arrays | 46 | ||
| Two-Dimensional Arrays | 46 | ||
| Transducer Selection | 46 | ||
| Image Display and Storage | 46 | ||
| Special Imaging Modes | 47 | ||
| Tissue Harmonic Imaging | 47 | ||
| Spatial Compounding | 47 | ||
| Three-Dimensional Ultrasound | 49 | ||
| Ultrasound Elastography | 49 | ||
| Strain Elastography | 50 | ||
| Shear Wave Elastography | 50 | ||
| Image Quality | 50 | ||
| Spatial Resolution | 50 | ||
| Imaging Pitfalls | 53 | ||
| Shadowing and Enhancement | 55 | ||
| Doppler Sonography | 55 | ||
| Doppler Signal Processing and Display | 57 | ||
| Doppler Instrumentation | 58 | ||
| Power Doppler | 59 | ||
| Interpretation of the Doppler Spectrum | 59 | ||
| Interpretation of Color Doppler | 62 | ||
| Other Technical Considerations | 62 | ||
| Doppler Frequency | 63 | ||
| Wall Filters | 63 | ||
| Spectral Broadening | 63 | ||
| Aliasing | 63 | ||
| Doppler Angle | 64 | ||
| Sample Volume Size | 64 | ||
| Doppler Gain | 64 | ||
| Operating Modes: Clinical Implications | 64 | ||
| Bioeffects and User Concerns | 65 | ||
| Therapeutic Applications: High-Intensity Focused Ultrasound | 65 | ||
| References | 67 | ||
| 2 Biologic Effects and Safety | 68 | ||
| Chapter Outline | 68 | ||
| Summary of Key Points | 68 | ||
| Regulation of Ultrasound Output | 68 | ||
| Physical Effects of Sound | 69 | ||
| Thermal Effects | 69 | ||
| Ultrasound Produces Heat | 69 | ||
| Factors Controlling Tissue Heating | 69 | ||
| Spatial Focusing | 69 | ||
| Temporal Considerations | 70 | ||
| Tissue Type | 70 | ||
| Bone Heating | 71 | ||
| Soft Tissue Heating | 71 | ||
| Hyperthermia and Ultrasound Safety | 72 | ||
| Thermal Index | 72 | ||
| Homogeneous Tissue Model (Soft Tissue) | 73 | ||
| Tissue Model With Bone at the Focus (Fetal Applications) | 73 | ||
| Tissue Model With Bone at the Surface (Transcranial Applications) | 73 | ||
| Estimate of Thermal Effects | 74 | ||
| Summary Statement on Thermal Effects | 74 | ||
| Effects of Acoustic Cavitation | 74 | ||
| Potential Sources for Bioeffects | 74 | ||
| Sonochemistry | 76 | ||
| Evidence of Cavitation From Lithotripters | 76 | ||
| Bioeffects in Lung and Intestine | 77 | ||
| Ultrasound Contrast Agents | 77 | ||
| Considerations for Increasing Acoustic Output | 78 | ||
| Mechanical Index | 78 | ||
| Summary Statement on Gas Body Bioeffects | 79 | ||
| Output Display Standard | 80 | ||
| General AIUM Safety Statements | 81 | ||
| Epidemiology | 82 | ||
| Controlling Ultrasound Output | 82 | ||
| Ultrasound Entertainment Videos | 84 | ||
| References | 84 | ||
| 3 Contrast Agents for Ultrasound | 87 | ||
| Chapter Outline | 87 | ||
| Summary of Key Points | 87 | ||
| Requirements and Types | 88 | ||
| Blood Pool Agents | 89 | ||
| Free Gas Bubbles | 89 | ||
| Encapsulated Air Bubbles | 89 | ||
| Second-Generation Agents | 90 | ||
| Selective Uptake Agents | 90 | ||
| The Need for Bubble-Specific Imaging | 90 | ||
| Bubble Behavior and Incident Pressure | 90 | ||
| The Mechanical Index | 92 | ||
| Nonlinear Echoes and Harmonic Imaging | 92 | ||
| Harmonic B-Mode Imaging | 94 | ||
| Harmonic Spectral and Power Doppler Imaging | 94 | ||
| Tissue Harmonic Imaging | 95 | ||
| Pulse Inversion Imaging | 96 | ||
| Pulse Inversion Doppler Imaging | 97 | ||
| Plane-Wave Contrast Imaging | 98 | ||
| Amplitude and Phase Modulation Imaging | 98 | ||
| Temporal Maximum Intensity Projection Imaging | 98 | ||
| Disrupting Bubbles: Intermittent Imaging | 98 | ||
| Triggered Imaging | 99 | ||
| Intermittent Harmonic Power Doppler | 100 | ||
| Disruption-Replenishment Imaging | 100 | ||
| Safety Considerations and Regulatory Status | 101 | ||
| The Future | 102 | ||
| Conclusion | 103 | ||
| References | 105 | ||
| II Abdominal and Pelvic Sonography | 108 | ||
| 4 The Liver | 108 | ||
| Chapter Outline | 108 | ||
| Summary of Key Points | 108 | ||
| Sonographic Technique | 109 | ||
| Normal Anatomy | 109 | ||
| Couinaud Anatomy | 110 | ||
| Ligaments | 111 | ||
| Hepatic Circulation | 112 | ||
| Portal Veins | 112 | ||
| Arterial Circulation | 112 | ||
| Hepatic Venous System | 114 | ||
| Normal Liver Size and Echogenicity | 114 | ||
| Developmental Anomalies | 114 | ||
| Agenesis | 114 | ||
| Anomalies of Position | 114 | ||
| Accessory Fissures | 114 | ||
| Vascular Anomalies | 114 | ||
| Congenital Abnormalities | 116 | ||
| Liver Cyst | 116 | ||
| Peribiliary Cysts | 116 | ||
| Autosomal Dominant Polycystic Disease | 117 | ||
| Biliary Hamartomas (von Meyenburg Complexes) | 117 | ||
| Infectious Diseases | 117 | ||
| Viral Hepatitis | 117 | ||
| Clinical Manifestations | 118 | ||
| Bacterial Diseases | 119 | ||
| Fungal Diseases: Candidiasis | 120 | ||
| Parasitic Diseases | 121 | ||
| Amebiasis | 121 | ||
| Hydatid Disease | 122 | ||
| Schistosomiasis | 124 | ||
| Pneumocystis carinii | 125 | ||
| Disorders of Metabolism | 125 | ||
| Fatty Liver | 125 | ||
| Glycogen Storage Disease (Glycogenosis) | 126 | ||
| Cirrhosis | 126 | ||
| Doppler Ultrasound Characteristics | 129 | ||
| Elastography | 129 | ||
| Vascular Abnormalities | 130 | ||
| Portal Hypertension | 130 | ||
| Portal Vein Thrombosis | 132 | ||
| Budd-Chiari Syndrome | 132 | ||
| Portal Vein Aneurysm | 137 | ||
| Intrahepatic Portosystemic Venous Shunts | 138 | ||
| Aneurysm, Pseudoaneurysm, and Dissection | 138 | ||
| Hereditary Hemorrhagic Telangiectasia | 138 | ||
| Peliosis Hepatis | 138 | ||
| Hepatic Masses | 139 | ||
| Liver Mass Characterization | 139 | ||
| Role of Microbubble Contrast Agents | 139 | ||
| Liver Mass Detection | 140 | ||
| Hepatic Neoplasms | 141 | ||
| Benign Hepatic Neoplasms | 142 | ||
| Cavernous Hemangioma | 142 | ||
| Focal Nodular Hyperplasia | 146 | ||
| Hepatic Adenoma | 149 | ||
| Fatty Tumors: Hepatic Lipomas and Angiomyolipomas | 151 | ||
| Malignant Hepatic Neoplasms | 152 | ||
| Hepatocellular Carcinoma | 152 | ||
| Hemangiosarcoma (Angiosarcoma) | 157 | ||
| Hepatic Epithelioid Hemangioendothelioma | 157 | ||
| Metastatic Liver Disease | 158 | ||
| Hepatic Trauma | 163 | ||
| Portosystemic Shunts | 164 | ||
| Transjugular Intrahepatic Portosystemic Shunts | 165 | ||
| Percutaneous Liver Biopsy | 166 | ||
| Intraoperative Ultrasound | 167 | ||
| Acknowledgment | 168 | ||
| References | 168 | ||
| 5 The Spleen | 173 | ||
| Chapter Outline | 173 | ||
| Summary of Key Points | 173 | ||
| Embryology and Anatomy | 173 | ||
| Sonographic Technique | 176 | ||
| Sonographic Appearance | 176 | ||
| Pathologic Conditions | 179 | ||
| Splenomegaly | 179 | ||
| Focal Abnormalities | 180 | ||
| Splenic Cysts | 180 | ||
| Nodular Splenic Lesions | 182 | ||
| Focal Solid Splenic Lesions | 186 | ||
| Malignancies. | 186 | ||
| Benign Lesions. | 187 | ||
| Other Abnormalities | 191 | ||
| Sickle Cell Disease | 191 | ||
| Gaucher Disease | 191 | ||
| Gamna-Gandy Bodies | 191 | ||
| Splenic Trauma | 192 | ||
| Congenital Anomalies | 192 | ||
| Interventional Procedures | 195 | ||
| Pitfalls in Interpretation | 195 | ||
| References | 196 | ||
| 6 The Biliary Tree and Gallbladder | 199 | ||
| Chapter Outline | 199 | ||
| Summary of Key Points | 199 | ||
| The Biliary Tree | 200 | ||
| Anatomy and Normal Variants | 200 | ||
| Sonographic Technique | 202 | ||
| Choledochal Cysts | 202 | ||
| Caroli Disease | 205 | ||
| Overview of Biliary Tree Obstruction | 205 | ||
| Choledocholithiasis | 206 | ||
| Intrahepatic Stones | 207 | ||
| Common Bile Duct Stones | 207 | ||
| Mirizzi Syndrome | 208 | ||
| Hemobilia | 208 | ||
| Pneumobilia | 209 | ||
| Biliary Tree Infection | 210 | ||
| Acute (Bacterial, Ascending) Cholangitis | 210 | ||
| Liver Flukes | 210 | ||
| Fascioliasis. | 210 | ||
| Clonorchiasis and Opisthorchiasis. | 212 | ||
| Recurrent Pyogenic Cholangitis | 213 | ||
| Ascariasis | 215 | ||
| HIV Cholangiopathy | 215 | ||
| Immune-Related Diseases of the Biliary Tree | 216 | ||
| Primary Biliary Cirrhosis and Autoimmune Cholangitis | 216 | ||
| Primary Sclerosing Cholangitis | 216 | ||
| IgG4-Related Cholangitis | 216 | ||
| Cholangiocarcinoma | 218 | ||
| Intrahepatic Cholangiocarcinoma | 218 | ||
| Hilar Cholangiocarcinoma | 219 | ||
| Patterns of Tumor Growth. | 220 | ||
| Treatment and Staging. | 220 | ||
| Assessment by Conventional and Doppler Sonography. | 221 | ||
| Assessment by Contrast-Enhanced Sonography. | 222 | ||
| Distal Cholangiocarcinoma | 222 | ||
| Metastases to Biliary Tree | 222 | ||
| The Gallbladder | 222 | ||
| Anatomy and Normal Variants | 222 | ||
| Sonographic Technique | 228 | ||
| Gallstone Disease | 228 | ||
| Biliary Sludge | 228 | ||
| Acute Cholecystitis | 229 | ||
| Gangrenous Cholecystitis | 234 | ||
| Perforated Gallbladder | 234 | ||
| Emphysematous Cholecystitis | 234 | ||
| Acalculous Cholecystitis | 234 | ||
| Torsion (Volvulus) of Gallbladder | 235 | ||
| Chronic Cholecystitis | 235 | ||
| Porcelain Gallbladder | 236 | ||
| Adenomyomatosis (Adenomatous Hyperplasia) | 236 | ||
| Polypoid Masses of Gallbladder | 237 | ||
| Cholesterol Polyps | 237 | ||
| Adenomas, Adenomyomas, and Inflammatory Polyps | 237 | ||
| Malignancies | 238 | ||
| Gallbladder Carcinoma | 240 | ||
| Patterns of Tumor Spread | 241 | ||
| Sonographic Appearance | 241 | ||
| References | 241 | ||
| 7 The Pancreas | 244 | ||
| Chapter Outline | 244 | ||
| Summary of Key Points | 244 | ||
| Anatomy and Sonographic Technique | 244 | ||
| Pancreatic Body | 245 | ||
| Pancreatic Head | 245 | ||
| Pancreatic Tail | 247 | ||
| Pancreatic Parenchyma | 247 | ||
| Fatty Pancreas | 249 | ||
| Embryology and Pancreatic Duct | 249 | ||
| Imaging Anatomic Variants | 252 | ||
| Peripancreatic Structures | 252 | ||
| Acute Pancreatitis | 253 | ||
| Approach to Imaging | 255 | ||
| Ultrasound Findings | 256 | ||
| Complications | 259 | ||
| Acute Fluid Collections | 262 | ||
| Pseudocysts | 262 | ||
| Necrosis and Abscess | 264 | ||
| Treatment | 264 | ||
| Vascular Complications | 264 | ||
| Chronic Pancreatitis | 264 | ||
| Approach to Imaging | 265 | ||
| Ultrasound Findings | 265 | ||
| Pseudocysts | 266 | ||
| Portal and Splenic Vein Thrombosis | 266 | ||
| Masses Associated With Chronic Pancreatitis | 267 | ||
| Pancreatic Neoplasms | 270 | ||
| Periampullary Neoplasm | 270 | ||
| Pancreatic Carcinoma | 270 | ||
| Detection of Pancreatic Cancer | 272 | ||
| Ultrasound Findings | 272 | ||
| Resectability Imaging | 275 | ||
| Color Doppler Ultrasound | 275 | ||
| Cystic Pancreatic Lesions | 276 | ||
| Simple Pancreatic Cysts | 277 | ||
| Cystic Neoplasms | 277 | ||
| Serous Cystic Neoplasm | 277 | ||
| Intraductal Papillary Mucinous Neoplasm | 279 | ||
| Mucinous Cystic Neoplasm | 281 | ||
| Solid-Pseudopapillary Tumor | 282 | ||
| Rare Cystic Tumors | 282 | ||
| Other Pancreatic Masses | 282 | ||
| Endocrine Tumors | 282 | ||
| Unusual and Rare Neoplasms | 283 | ||
| Lipoma | 283 | ||
| Metastatic Tumors | 285 | ||
| Contrast-Enhanced Ultrasound | 285 | ||
| Acknowledgment | 285 | ||
| References | 285 | ||
| 8 The Gastrointestinal Tract | 290 | ||
| Chapter Outline | 290 | ||
| Summary of Key Points | 290 | ||
| Anatomy and Sonographic Technique | 291 | ||
| The Gut Signature | 291 | ||
| Gut Wall Pathology | 291 | ||
| Imaging Technique | 292 | ||
| Doppler Evaluation of Gut Wall | 294 | ||
| Contrast-Enhanced Ultrasound and Elastography of the Bowel | 295 | ||
| Gastrointestinal Tract Neoplasms | 295 | ||
| Adenocarcinoma | 295 | ||
| Gastrointestinal Stromal Tumors | 298 | ||
| Lymphoma | 298 | ||
| Metastases | 300 | ||
| Inflammatory Bowel Disease: Crohn Disease | 300 | ||
| Classic Features | 303 | ||
| Gut Wall Thickening | 303 | ||
| Inflammatory Fat | 303 | ||
| Lymphadenopathy | 303 | ||
| Hyperemia | 303 | ||
| Mucosal Abnormalities | 303 | ||
| Conglomerate Masses | 303 | ||
| Complications | 303 | ||
| Strictures | 303 | ||
| Incomplete Mechanical Bowel Obstruction | 308 | ||
| Localized Perforation | 308 | ||
| Inflammatory Masses | 309 | ||
| Fistula Formation | 310 | ||
| Perianal Inflammatory Disease | 310 | ||
| Acute Abdomen | 311 | ||
| Right Lower Quadrant Pain | 316 | ||
| Acute Appendicitis | 316 | ||
| Crohn Appendicitis | 319 | ||
| Right-Sided Diverticulitis | 319 | ||
| Acute Typhlitis | 321 | ||
| Mesenteric Adenitis With Terminal Ileitis | 322 | ||
| Right-Sided Segmental Omental Infarction | 322 | ||
| Left Lower Quadrant Pain | 322 | ||
| Acute Diverticulitis | 322 | ||
| Other Abnormalities | 327 | ||
| Mechanical Bowel Obstruction | 327 | ||
| Paralytic Ileus | 329 | ||
| Gut Edema | 329 | ||
| Gastrointestinal Tract Infections | 329 | ||
| AIDS Patients | 330 | ||
| Pseudomembranous Colitis | 330 | ||
| Congenital Cysts | 331 | ||
| Ischemic Bowel Disease | 331 | ||
| Pneumatosis Intestinalis | 331 | ||
| Mucocele of Appendix | 333 | ||
| Gastrointestinal Tract Hematoma | 333 | ||
| Peptic Ulcer | 333 | ||
| Bezoars | 334 | ||
| Intraluminal Foreign Bodies | 334 | ||
| Celiac Disease | 334 | ||
| Cystic Fibrosis | 334 | ||
| Endosonography | 334 | ||
| Upper Gastrointestinal Tract | 334 | ||
| Rectum: Tumor Staging of Rectal Carcinoma | 335 | ||
| Anal Canal | 336 | ||
| Fecal Incontinence | 339 | ||
| Perianal Inflammatory Disease | 339 | ||
| Acknowledgment | 341 | ||
| References | 342 | ||
| 9 The Kidney and Urinary Tract | 344 | ||
| Chapter Outline | 344 | ||
| Summary of Key Points | 344 | ||
| Embryology | 345 | ||
| Development of the Kidneys and Ureter | 345 | ||
| Development of the Bladder | 345 | ||
| Development of the Urethra | 345 | ||
| Anatomy | 345 | ||
| Kidney | 345 | ||
| 9780323529631v2_WEB | 1154 | ||
| Front Cover | 1154 | ||
| Diagnostic Ultrasound, 2-Volume Set | 1155 | ||
| Copyright Page | 1158 | ||
| About the Editors | 1159 | ||
| Contributors | 1161 | ||
| Dedication | 1169 | ||
| Preface | 1171 | ||
| Acknowledgments | 1173 | ||
| Table Of Contents | 1175 | ||
| Video Contents | 1177 | ||
| IV Obstetric and Fetal Sonography | 1187 | ||
| 28 Overview of Obstetric Imaging | 1187 | ||
| Chapter Outline | 1187 | ||
| Summary of Key Points | 1187 | ||
| Training, Personnel, and Equipment | 1187 | ||
| Ultrasound Guidelines | 1188 | ||
| First Trimester | 1188 | ||
| Second and Third Trimesters | 1191 | ||
| Routine Ultrasound Screening | 1194 | ||
| Estimation of Gestational Age | 1194 | ||
| Identification of Twin/Multiple Pregnancies | 1201 | ||
| Screening and Perinatal Outcomes | 1201 | ||
| Fetal Malformations: Diagnostic Accuracy | 1202 | ||
| Three-Dimensional Ultrasound | 1202 | ||
| Prudent Use of Ultrasound | 1202 | ||
| Magnetic Resonance Imaging | 1203 | ||
| Conclusion | 1204 | ||
| References | 1204 | ||
| 29 Bioeffects and Safety of Ultrasound in Obstetrics | 1206 | ||
| Chapter Outline | 1206 | ||
| Summary of Key Points | 1206 | ||
| Instrument Outputs | 1207 | ||
| Scanning Mode | 1207 | ||
| System Setup | 1207 | ||
| Dwell Time | 1208 | ||
| Thermal Effects | 1208 | ||
| Mechanical Effects | 1210 | ||
| Bioeffects of Ultrasound | 1210 | ||
| Animal Research | 1210 | ||
| Human Studies | 1211 | ||
| Birth Weight | 1212 | ||
| Delayed Speech | 1212 | ||
| Dyslexia | 1212 | ||
| Nonright-Handedness | 1212 | ||
| Neurologic Development and Behavioral Issues | 1212 | ||
| Congenital Malformations | 1213 | ||
| Childhood Malignancies | 1213 | ||
| Is Doppler Different? | 1213 | ||
| Safety Guidelines | 1213 | ||
| Conclusion | 1214 | ||
| References | 1215 | ||
| 30 The First Trimester | 1220 | ||
| Chapter Outline | 1220 | ||
| Summary of Key Points | 1220 | ||
| Maternal Physiology and Embryology | 1221 | ||
| Sonographic Appearance of Normal Intrauterine Pregnancy | 1226 | ||
| Gestational Sac | 1226 | ||
| β-hCG and Early Pregnancy Ultrasound | 1227 | ||
| Yolk Sac | 1229 | ||
| Embryo and Amnion | 1229 | ||
| Embryonic Cardiac Activity | 1230 | ||
| Umbilical Cord and Cord Cyst | 1231 | ||
| Estimation of Gestational Age | 1233 | ||
| Gestational Sac Size | 1233 | ||
| Crown-Rump Length | 1234 | ||
| Early Pregnancy Failure | 1234 | ||
| Diagnostic Findings of Early Pregnancy Failure | 1235 | ||
| Crown-Rump Length 7 mm or Greater and No Heartbeat | 1235 | ||
| Gestational Sac Mean Sac Diameter 25 mm or Greater and No Embryo | 1235 | ||
| Worrisome Findings of Early Pregnancy Failure | 1236 | ||
| Embryos With Crown-Rump Length Less Than 7 mm and No Heartbeat | 1236 | ||
| Gestational Sac With Mean Sac Diameter 16 to 24 mm and No Embryo | 1236 | ||
| Gestational Sac Appearance | 1237 | ||
| Small Mean Sac Diameter in Relationship to Crown-Rump Length | 1238 | ||
| Abnormally Large Amnion With Respect to Embryo Size | 1238 | ||
| Yolk Sac Size and Shape | 1239 | ||
| Embryonic Bradycardia | 1240 | ||
| Subchorionic Hemorrhage | 1241 | ||
| Ectopic Pregnancy | 1241 | ||
| Clinical Presentation | 1241 | ||
| Sonographic Diagnosis | 1242 | ||
| Heterotopic Gestation | 1243 | ||
| Serum β-hCG Levels | 1243 | ||
| Specific Sonographic Findings | 1243 | ||
| Nonspecific Sonographic Findings | 1244 | ||
| Adnexal Mass | 1244 | ||
| Free Fluid | 1244 | ||
| Endometrium | 1244 | ||
| Implantation Sites | 1245 | ||
| Pregnancy of Unknown Location | 1247 | ||
| Management | 1247 | ||
| Evaluation of the Embryo | 1248 | ||
| Normal Embryologic Findings Mimicking Pathology | 1249 | ||
| Rhombencephalon | 1249 | ||
| Physiologic Anterior Abdominal Wall Herniation | 1249 | ||
| Abnormal Embryos | 1249 | ||
| Gestational Trophoblastic Disease | 1249 | ||
| Hydatidiform Molar Pregnancy | 1250 | ||
| Complete Molar Pregnancy | 1250 | ||
| Partial Molar Pregnancy | 1250 | ||
| Coexistent Hydatidiform Mole and Normal Fetus | 1250 | ||
| Persistent Trophoblastic Neoplasia | 1252 | ||
| Invasive Mole | 1252 | ||
| Choriocarcinoma | 1252 | ||
| Placental-Site Trophoblastic Tumor | 1254 | ||
| Sonographic Features of Persistent Trophoblastic Neoplasia | 1254 | ||
| Diagnosis and Treatment | 1255 | ||
| Conclusion | 1256 | ||
| References | 1256 | ||
| 31 Chromosomal Abnormalities | 1260 | ||
| Chapter Outline | 1260 | ||
| Summary of Key Points | 1260 | ||
| First-Trimester Screening for Aneuploidy | 1261 | ||
| Nuchal Translucency and Trisomy 21 | 1261 | ||
| Serum Biochemical Markers | 1261 | ||
| Combined First-Trimester Screening | 1262 | ||
| Integrated and Sequential Screening | 1263 | ||
| Standardization of Nuchal Translucency Measurement Technique | 1263 | ||
| Nuchal Translucency and Other Aneuploidies | 1265 | ||
| Cystic Hygroma | 1265 | ||
| Nasal Bone | 1265 | ||
| Other Markers for Aneuploidy | 1267 | ||
| Reversed Flow in Ductus Venosus | 1267 | ||
| Tricuspid Regurgitation | 1267 | ||
| Thickened Nuchal Translucency With Normal Karyotype | 1267 | ||
| Second-Trimester Screening for Trisomy 21 | 1269 | ||
| Nuchal Fold | 1269 | ||
| Facial Profile (Nasal Bone) | 1271 | ||
| Femur Length | 1272 | ||
| Humerus Length | 1273 | ||
| Urinary Tract Dilation | 1273 | ||
| Echogenic Bowel | 1273 | ||
| Echogenic Intracardiac Focus | 1273 | ||
| Structural Anomalies | 1273 | ||
| Adjunct Features of Trisomy 21 | 1273 | ||
| Combined Markers | 1273 | ||
| Trisomy 18 (Edwards Syndrome) | 1275 | ||
| Choroid Plexus Cysts | 1276 | ||
| Trisomy 13 (Patau Syndrome) | 1276 | ||
| Triploidy | 1276 | ||
| Monosomy X (Turner Syndrome) | 1278 | ||
| Prenatal Screening for Aneuploidy With Cell-Free DNA | 1279 | ||
| Diagnostic Testing | 1279 | ||
| Conclusion | 1281 | ||
| References | 1281 | ||
| 32 Multifetal Pregnancy | 1287 | ||
| Chapter Outline | 1287 | ||
| Summary of Key Points | 1287 | ||
| Zygosity/Chorionicity | 1287 | ||
| Determination of Chorionicity | 1289 | ||
| General Issues | 1291 | ||
| Loss of a Twin | 1295 | ||
| Complications of Monochorionicity | 1297 | ||
| Twin-Twin Transfusion Syndrome | 1297 | ||
| Twin Anemia Polycythemia Sequence | 1298 | ||
| Twin Reversed Arterial Perfusion Sequence | 1299 | ||
| Monoamniotic Twins | 1301 | ||
| Conjoined Twins | 1301 | ||
| References | 1302 | ||
| 33 The Fetal Face and Neck | 1305 | ||
| Chapter Outline | 1305 | ||
| Summary Key Points | 1305 | ||
| Embryology and Development | 1305 | ||
| Face | 1305 | ||
| Neck | 1306 | ||
| Sonography of the Normal Fetal Face | 1306 | ||
| Abnormalities of the Head | 1307 | ||
| Abnormal Size | 1307 | ||
| Abnormal Shape | 1308 | ||
| Craniosynostosis | 1308 | ||
| Wormian Bones | 1311 | ||
| Forehead Abnormalities | 1311 | ||
| Encephaloceles | 1311 | ||
| Orbit Abnormalities | 1312 | ||
| Hypotelorism | 1312 | ||
| Hypertelorism | 1312 | ||
| Microphthalmia and Anophthalmia | 1312 | ||
| Coloboma | 1315 | ||
| Dacryocystocele | 1315 | ||
| Congenital Cataracts | 1315 | ||
| Ear Abnormalities | 1320 | ||
| Midface Abnormalities | 1320 | ||
| Hypoplasia | 1320 | ||
| Absent Nasal Bone | 1322 | ||
| Other Nasal Abnormalities | 1323 | ||
| Cleft Lip and Palate | 1323 | ||
| Unilateral Cleft Lip or Palate | 1324 | ||
| Bilateral Cleft Lip or Palate | 1324 | ||
| Median Cleft Lip or Palate | 1324 | ||
| Unusual Facial (Tessier) Clefts | 1324 | ||
| Isolated Cleft of Secondary Palate | 1325 | ||
| Lower Face Abnormalities | 1325 | ||
| Macroglossia and Oral Masses | 1325 | ||
| Micrognathia and Retrognathia | 1325 | ||
| Soft Tissue Tumors | 1326 | ||
| Neck Abnormalities | 1326 | ||
| Nuchal Translucency and Thickening | 1326 | ||
| Lymphatic Malformation (Cystic Hygroma) | 1331 | ||
| Cervical Teratoma | 1331 | ||
| Thyromegaly and Goiter | 1331 | ||
| Conclusion | 1335 | ||
| Acknowledgments | 1335 | ||
| References | 1335 | ||
| 34 The Fetal Brain | 1338 | ||
| Chapter Outline | 1338 | ||
| Summary of Key Points | 1338 | ||
| Developmental Anatomy | 1339 | ||
| Embryology | 1339 | ||
| Sonographic Anatomy | 1339 | ||
| Variants (Usually Normal) | 1342 | ||
| Choroid Plexus Cysts | 1342 | ||
| Blake Pouch Cyst | 1342 | ||
| Cavum Veli Interpositi | 1342 | ||
| Ventriculomegaly and Hydrocephalus | 1346 | ||
| Pathogenesis of Ventriculomegaly | 1349 | ||
| Ultrasound Evaluation of Ventriculomegaly | 1350 | ||
| Specific Abnormalities | 1351 | ||
| Errors of Dorsal Induction | 1351 | ||
| Anencephaly and Exencephaly | 1351 | ||
| Cephalocele and Encephalocele | 1351 | ||
| Ciliopathies | 1354 | ||
| Joubert Syndrome | 1354 | ||
| Meckel-Gruber Syndrome | 1354 | ||
| Amniotic Band Sequence/Limb–Body Wall Complex | 1354 | ||
| Cranial Changes in Spina Bifida | 1355 | ||
| Errors of Ventral Induction | 1358 | ||
| Holoprosencephaly | 1358 | ||
| Posterior Fossa and Cerebellum | 1361 | ||
| Dandy-Walker Malformation | 1362 | ||
| Vermis Hypoplasia or Dysplasia | 1362 | ||
| Mega–Cisterna Magna | 1364 | ||
| Rhombencephalosynapsis | 1364 | ||
| Other Posterior Fossa Abnormalities | 1364 | ||
| Arachnoid Cysts | 1364 | ||
| Malformations of Cortical Development | 1365 | ||
| Microcephaly | 1366 | ||
| Macrocephaly and Megalencephaly | 1366 | ||
| Hemimegalencephaly | 1367 | ||
| Lissencephaly | 1367 | ||
| Focal Cortical Changes | 1368 | ||
| Other Malformations of Cortical Development | 1368 | ||
| Tuberous Sclerosis | 1370 | ||
| Agenesis and Dysgenesis of Corpus Callosum | 1371 | ||
| Absence of Septi Pellucidi and Septo-Optic Dysplasia | 1373 | ||
| Intracranial Calcifications | 1375 | ||
| Infections | 1375 | ||
| Vascular Malformations | 1376 | ||
| Thrombosis of Dural Sinuses | 1377 | ||
| Hemorrhagic Lesions | 1378 | ||
| Hydranencephaly | 1380 | ||
| Tumors | 1380 | ||
| Conclusion | 1382 | ||
| Acknowledgments | 1382 | ||
| References | 1382 | ||
| 35 The Fetal Spine | 1388 | ||
| Chapter Outline | 1388 | ||
| Summary of Key Points | 1388 | ||
| Developmental Anatomy | 1388 | ||
| Embryology of the Spine | 1388 | ||
| Ossification of the Fetal Spine | 1390 | ||
| Normal Position of the Spinal Cord | 1390 | ||
| Scanning Techniques | 1393 | ||
| Three-Dimensional Ultrasound | 1393 | ||
| Spina Bifida | 1395 | ||
| Folic Acid Fortification | 1396 | ||
| Pathogenesis and Pathology | 1398 | ||
| Alpha-Fetoprotein and Ultrasound Screening | 1398 | ||
| Sonographic Findings in the Spine | 1400 | ||
| Associated Cranial Abnormalities | 1400 | ||
| Associated Noncranial Abnormalities | 1405 | ||
| Prognosis | 1405 | ||
| Fetal Surgery for Myelomeningocele | 1405 | ||
| Myelocystocele | 1405 | ||
| Diastematomyelia | 1406 | ||
| Scoliosis and Kyphosis | 1407 | ||
| Sacral Agenesis | 1409 | ||
| Caudal Regression | 1409 | ||
| Sirenomelia | 1410 | ||
| Sacrococcygeal Teratoma | 1410 | ||
| Presacral Fetal Mass | 1411 | ||
| References | 1411 | ||
| 36 The Fetal Chest | 1415 | ||
| Chapter Outline | 1415 | ||
| Summary of Key Points | 1415 | ||
| Development of Structures in the Chest | 1415 | ||
| Pulmonary Development | 1415 | ||
| Normal Sonographic Features of the Fetal Chest | 1416 | ||
| Normal Diaphragm | 1417 | ||
| Normal Thymus | 1417 | ||
| Pulmonary Hypoplasia, Aplasia, and Agenesis | 1417 | ||
| Congenital Pulmonary Airway Malformation Spectrum | 1418 | ||
| Congenital Pulmonary Airway Malformation | 1418 | ||
| Bronchopulmonary Sequestration | 1422 | ||
| Congenital Lobar Overinflation | 1423 | ||
| Pleuropulmonary Blastoma | 1424 | ||
| Congenital High Airway Obstruction | 1425 | ||
| Bronchogenic Cyst | 1427 | ||
| Neurenteric Cyst | 1428 | ||
| Pleural Effusion | 1428 | ||
| Pericardial Effusion | 1430 | ||
| Pulmonary Lymphangiectasia | 1430 | ||
| Congenital Diaphragmatic Hernia | 1430 | ||
| Other Hernias and Eventration | 1434 | ||
| Associated Anomalies | 1435 | ||
| Morbidity and Mortality | 1436 | ||
| In Utero Therapy | 1436 | ||
| Conclusion | 1436 | ||
| References | 1436 | ||
| 37 The Fetal Heart | 1442 | ||
| Chapter Outline | 1442 | ||
| Summary of Key Points | 1442 | ||
| Normal Fetal Cardiac Anatomy and Scanning Techniques | 1445 | ||
| Structural Anomalies | 1449 | ||
| Atrial Septal Defect | 1449 | ||
| Ventricular Septal Defect | 1453 | ||
| Atrioventricular Septal Defect | 1456 | ||
| Ebstein Anomaly | 1458 | ||
| Hypoplastic Right Ventricle | 1459 | ||
| Hypoplastic Left Heart Syndrome | 1459 | ||
| Univentricular Heart | 1459 | ||
| Tetralogy of Fallot | 1460 | ||
| Truncus Arteriosus | 1460 | ||
| Double-Outlet Right Ventricle | 1460 | ||
| Transposition of Great Arteries | 1461 | ||
| Anomalous Pulmonary Venous Return | 1462 | ||
| Coarctation of Aorta | 1463 | ||
| Aortic Stenosis | 1464 | ||
| Pulmonic Stenosis | 1464 | ||
| Cardiosplenic Syndromes | 1464 | ||
| Cardiac Tumors | 1465 | ||
| Cardiomyopathy | 1466 | ||
| Ectopia Cordis | 1467 | ||
| Arrhythmias | 1467 | ||
| Premature Atrial and Ventricular Contractions | 1467 | ||
| Tachycardia | 1468 | ||
| Bradycardia | 1469 | ||
| Congenital Heart Block | 1469 | ||
| References | 1470 | ||
| 38 The Fetal Gastrointestinal Tract and Abdominal Wall | 1476 | ||
| Chapter Outline | 1476 | ||
| Summary of Key Points | 1476 | ||
| The Gastrointestinal Tract | 1476 | ||
| Embryology of the Digestive Tube | 1476 | ||
| Esophagus | 1477 | ||
| Esophageal Atresia | 1477 | ||
| Stomach | 1478 | ||
| Small or Absent Fetal Stomach | 1478 | ||
| Dilated Fetal Stomach | 1479 | ||
| Midline or Right-Sided Stomach | 1479 | ||
| Intraluminal Gastric Masses | 1480 | ||
| Small Bowel and Colon | 1480 | ||
| Bowel Obstruction | 1480 | ||
| Duodenal Obstruction. | 1480 | ||
| Jejunal and Ileal Obstruction. | 1482 | ||
| Meconium Ileus | 1482 | ||
| Anorectal Malformations | 1482 | ||
| Hirschsprung Disease | 1484 | ||
| Enteric Duplication Cysts | 1484 | ||
| Meconium Peritonitis and Pseudocyst | 1485 | ||
| Echogenic Bowel | 1485 | ||
| Aneuploidy. | 1487 | ||
| Cystic Fibrosis. | 1488 | ||
| Intraamniotic Bleeding. | 1488 | ||
| Fetal Infection. | 1488 | ||
| Bowel Obstruction. | 1488 | ||
| Fetal Growth Restriction and Fetal Demise. | 1488 | ||
| Summary. | 1488 | ||
| Liver | 1488 | ||
| Hepatomegaly | 1488 | ||
| Hepatic Calcifications | 1488 | ||
| Hepatic Cysts and Masses | 1490 | ||
| Gallbladder and Biliary System | 1490 | ||
| Nonvisualization of the Gallbladder | 1490 | ||
| Fetal Gallstones | 1491 | ||
| Choledochal Cyst | 1491 | ||
| Pancreas | 1491 | ||
| Annular Pancreas | 1492 | ||
| Pancreatic Cysts | 1492 | ||
| Spleen | 1492 | ||
| Splenomegaly | 1492 | ||
| Splenic Cysts | 1492 | ||
| Abdominal Wall | 1494 | ||
| Embryology | 1494 | ||
| Gastroschisis | 1494 | ||
| Epidemiology | 1494 | ||
| Pathogenesis | 1495 | ||
| Prenatal Diagnosis | 1495 | ||
| Associated Conditions | 1496 |