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IV. Gastrointestinal and Genitourinary Tracts

IV. Gastrointestinal and Genitourinary Tracts

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Diagnostic Imaging Obstetrics,

2nd Edition



Diagnostic Imaging Obstetrics, 2nd Edition



Table of Contents

Diagnostic Imaging Obstetrics, 2nd Edition .................................................................................................. 8

Cover ....................................................................................................................................................... 8

Authors.................................................................................................................................................... 8

Dedication ..............................................................................................................................................10

Preface ...................................................................................................................................................10

Acknowledgements ................................................................................................................................11

Section 1 - First Trimester .......................................................................................................................12

I. Introduction and Overview...............................................................................................................12

1. Embryology and Anatomy of the First Trimester ..........................................................................12

2. Approach to the First Trimester ...................................................................................................27

II. Intrauterine Gestation.....................................................................................................................32

3. Failed First Trimester Pregnancy ..................................................................................................32

4. Perigestational Hemorrhage ........................................................................................................39

5. Chorionic Bump...........................................................................................................................45

III. Ectopic Gestation ...........................................................................................................................48

6. Tubal Ectopic ...............................................................................................................................48

7. Interstitial Ectopic .......................................................................................................................58

8. Cervical Ectopic ...........................................................................................................................64

9. C-Section Scar Ectopic .................................................................................................................71

10. Abdominal Ectopic.....................................................................................................................74

11. Heterotopic Pregnancy ..............................................................................................................77

Section 2 - Brain......................................................................................................................................80

I. Introduction and Overview...............................................................................................................80

12. Embryology and Anatomy of the Brain ......................................................................................80

13. Approach to the Supratentorial Brain ........................................................................................99

14. Approach to the Posterior Fossa ..............................................................................................107

II. Cranial Defects ..............................................................................................................................116

15. Exencephaly, Anencephaly ......................................................................................................116

16. Acalvaria, Acrania ....................................................................................................................122

17. Occipital, Parietal Cephalocele ................................................................................................128

18. Frontal Cephalocele.................................................................................................................137

III. Midline Developmental Anomalies ...............................................................................................141

19. Agenesis of the Corpus Callosum .............................................................................................141

20. Atelencephaly, Aprosencephaly...............................................................................................147

21. Alobar Holoprosencephaly ......................................................................................................153

22. Semilobar Holoprosencephaly .................................................................................................160

23. Lobar Holoprosencephaly ........................................................................................................166

24. Septo-Optic Dysplasia ..............................................................................................................172

25. Syntelencephaly ......................................................................................................................178

IV. Cortical Developmental Anomalies...............................................................................................184

26. Schizencephaly ........................................................................................................................184

27. Lissencephaly ..........................................................................................................................191

28. Gray Matter Heterotopia .........................................................................................................197

29. Pachygyria, Polymicrogyria ......................................................................................................200

V. Cysts .............................................................................................................................................206

30. Choroid Plexus Cyst .................................................................................................................206

31. Arachnoid Cyst ........................................................................................................................213

32. Glioependymal Cyst.................................................................................................................219

VI. Destructive Lesions ......................................................................................................................226

33. Intracranial Hemorrhage .........................................................................................................226

34. Encephalomalacia, Porencephaly ............................................................................................232

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Diagnostic Imaging Obstetrics, 2nd Edition

35. Hydranencephaly ....................................................................................................................239

VII. Posterior Fossa Malformations....................................................................................................245

36. Aqueductal Stenosis ................................................................................................................245

37. Chiari 2 ....................................................................................................................................252

38. Chiari 3 ....................................................................................................................................259

39. Dandy-Walker Malformation ...................................................................................................262

40. Vermian Agenesis - Partial Or Complete ..................................................................................268

41. Blake Pouch Cyst .....................................................................................................................272

42. Mega Cisterna Magna..............................................................................................................278

43. Cerebellar Hypoplasia..............................................................................................................281

44. Rhombencephalosynapsis .......................................................................................................287

VIII. Vascular Malformations .............................................................................................................290

45. Vein of Galen Malformation ....................................................................................................290

46. Arteriovenous Fistula ..............................................................................................................296

47. Dural Sinus Malformation ........................................................................................................300

IX. Tumors.........................................................................................................................................303

48. Parenchymal Brain Tumors ......................................................................................................303

49. Choroid Plexus Papilloma ........................................................................................................309

50. Lipoma ....................................................................................................................................313

Section 3 - Spine ...................................................................................................................................316

51. Embryology and Anatomy of the Spine ........................................................................................316

52. Approach to the Fetal Spine ........................................................................................................327

53. Spina Bifida .................................................................................................................................329

54. Iniencephaly................................................................................................................................336

55. Caudal Regression Sequence .......................................................................................................343

56. Kyphosis, Scoliosis .......................................................................................................................350

57. Tethered Cord .............................................................................................................................357

58. Diastematomyelia .......................................................................................................................360

59. Sacrococcygeal Teratoma ............................................................................................................363

Section 4 - Face and Neck .....................................................................................................................369

60. Embryology and Anatomy of the Face and Neck ..........................................................................369

61. Approach to the Fetal Face and Neck ..........................................................................................383

62. Cleft Lip, Palate ...........................................................................................................................389

63. Absent Nasal Bone ......................................................................................................................399

64. Dacrocystocele ............................................................................................................................406

65. Coloboma....................................................................................................................................409

66. Epignathus ..................................................................................................................................412

67. Goiter..........................................................................................................................................418

68. Cystic Hygroma ...........................................................................................................................425

69. Cervical Teratoma .......................................................................................................................432

Section 5 - Chest ...................................................................................................................................438

70. Embryology and Anatomy of the Chest........................................................................................438

71. Approach to the Fetal Chest ........................................................................................................449

72. Congenital Diaphragmatic Hernia ................................................................................................452

73. Congenital Pulmonary Airway Malformation ...............................................................................459

74. Pleural Effusion ...........................................................................................................................465

75. Bronchopulmonary Sequestration ...............................................................................................472

76. Bronchogenic Cyst .......................................................................................................................479

77. Congenital High Airway Obstruction Sequence ............................................................................482

78. Pulmonary Agenesis ....................................................................................................................485

79. Lymphangioma............................................................................................................................488

80. Mediastinal, Pulmonary Teratoma...............................................................................................495

Section 6 - Heart ...................................................................................................................................498

I. Introduction and Overview.............................................................................................................498

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Diagnostic Imaging Obstetrics, 2nd Edition

81. Embryology and Anatomy of the Cardiovascular System..........................................................498

82. Approach to the Fetal Heart ....................................................................................................515

II. Abnormal Location ........................................................................................................................524

83. Situs Inversus ..........................................................................................................................524

84. Heterotaxy, Cardiosplenic Syndromes .....................................................................................527

85. Ectopia Cordis .........................................................................................................................533

III. Septal Defects ..............................................................................................................................540

86. Ventricular Septal Defect .........................................................................................................540

87. Atrioventricular Septal Defect .................................................................................................543

88. Foramen Ovale Aneurysm .......................................................................................................549

IV. Right Heart Malformations...........................................................................................................553

89. Ebstein Anomaly......................................................................................................................553

90. Tricuspid Dysplasia ..................................................................................................................556

91. Tricuspid Atresia......................................................................................................................559

92. Pulmonary Stenosis, Atresia ....................................................................................................562

V. Left Heart Malformations ..............................................................................................................568

93. Hypoplastic Left Heart .............................................................................................................568

94. Coarctation and Interrupted Aortic Arch ..................................................................................575

95. Aortic Stenosis.........................................................................................................................581

96. Double Inlet Left Ventricle .......................................................................................................588

VI. Conotruncal Malformations .........................................................................................................591

97. Tetralogy of Fallot ...................................................................................................................591

98. Transposition of the Great Arteries..........................................................................................598

99. Truncus Arteriosus ..................................................................................................................604

100. Double Outlet Right Ventricle ................................................................................................611

VII. Myocardial and Pericardial Abnormalities ...................................................................................614

101. Echogenic Cardiac Focus ........................................................................................................614

102. Hypertrophic Cardiomyopathy...............................................................................................618

103. Dilated Cardiomyopathy ........................................................................................................624

104. Rhabdomyoma ......................................................................................................................631

105. Pericardial Effusion................................................................................................................637

106. Pericardial Teratoma .............................................................................................................641

VIII. Abnormal Rhythm ......................................................................................................................644

107. Irregular Rhythm ...................................................................................................................644

108. Tachyarrhythmia ...................................................................................................................647

109. Bradyarrhythmia ...................................................................................................................653

Section 7 - Abdominal Wall and Gastrointestinal Tract ..........................................................................660

I. Introduction and Overview.............................................................................................................660

110. Embryology and Anatomy of the Abdominal Wall and GI Tract ..............................................660

111. Approach to the Abdominal Wall and Gi Tract .......................................................................674

II. Abdominal Wall Defects ................................................................................................................682

112. Gastroschisis .........................................................................................................................682

113. Omphalocele .........................................................................................................................688

114. Pentalogy of Cantrell .............................................................................................................695

115. Body Stalk Anomaly ...............................................................................................................698

116. Bladder Exstrophy .................................................................................................................705

117. Cloacal Exstrophy - OEIS Syndrome........................................................................................708

III. Bowel Abnormalities ....................................................................................................................714

118. Esophageal Atresia ................................................................................................................714

119. Duodenal Atresia ...................................................................................................................720

120. Jejunal Ileal Atresia................................................................................................................727

121. Anal Atresia ...........................................................................................................................733

122. Cloacal Malformation ............................................................................................................739

123. Volvulus ................................................................................................................................746

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Diagnostic Imaging Obstetrics, 2nd Edition

124. Enteric Duplication Cyst .........................................................................................................749

IV. Peritoneal Abnormalities .............................................................................................................752

125. Ascites ...................................................................................................................................752

126. Meconium Peritonitis, Pseudocyst .........................................................................................759

127. Mesenteric Cyst.....................................................................................................................765

V. Hepatobiliary Abnormalities..........................................................................................................769

128. Gallstones .............................................................................................................................769

129. Choledochal Cyst ...................................................................................................................772

130. Infantile Hemangioendothelioma ..........................................................................................775

131. Mesenchymal Hamartoma ....................................................................................................781

132. Malignant Liver Tumors .........................................................................................................785

Section 8 - Genitourinary Tract .............................................................................................................791

I. Introduction and Overview.............................................................................................................791

133. Embryology and Anatomy of the Genitourinary Tract ............................................................791

134. Approach to the Fetal Genitourinary Tract .............................................................................808

II. Renal Developmental Variants ......................................................................................................813

135. Unilateral Renal Agenesis ......................................................................................................813

136. Duplicated Collecting System.................................................................................................817

137. Pelvic Kidney .........................................................................................................................823

138. Horseshoe Kidney ..................................................................................................................826

139. Crossed Fused Ectopia ...........................................................................................................829

III. Renal Malformations ....................................................................................................................833

140. Bilateral Renal Agenesis.........................................................................................................833

141. Mild Pelviectasis ....................................................................................................................839

142. Ureteropelvic Junction Obstruction .......................................................................................846

143. Urinoma ................................................................................................................................853

144. Obstructive Renal Dysplasia...................................................................................................856

145. Multicystic Dysplastic Kidney .................................................................................................863

146. Autosomal Recessive Polycystic Kidney Disease .....................................................................870

147. Mesoblastic Nephroma .........................................................................................................876

IV. Adrenal Abnormalities .................................................................................................................882

148. Adrenal Hemorrhage .............................................................................................................882

149. Neuroblastoma .....................................................................................................................886

V. Bladder Malformations .................................................................................................................892

150. Posterior Urethral Valves.......................................................................................................892

151. Prune Belly Syndrome ...........................................................................................................898

152. Ureterocele ...........................................................................................................................905

153. Urachal Anomalies.................................................................................................................911

VI. Genital Abnormalities ..................................................................................................................917

154. Ambiguous Genitalia .............................................................................................................917

155. Hypospadias ..........................................................................................................................928

156. Hydrocele ..............................................................................................................................931

157. Testicular Torsion ..................................................................................................................934

158. Inguinal Hernia ......................................................................................................................938

159. Ovarian Cyst ..........................................................................................................................941

160. Hydrocolpos ..........................................................................................................................947

Section 9 - Musculoskeletal...................................................................................................................951

I. Dysplasias ......................................................................................................................................951

161. Approach to Skeletal Dysplasias.............................................................................................951

162. Achondrogenesis, Hypochondrogenesis ................................................................................962

163. Achondroplasia .....................................................................................................................971

164. Amelia, Micromelia ...............................................................................................................978

165. Asphyxiating Thoracic Dysplasia ............................................................................................984

166. Atelosteogenesis ...................................................................................................................990

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Diagnostic Imaging Obstetrics, 2nd Edition

167. Campomelic Dysplasia ...........................................................................................................993

168. Chondrodysplasia Punctata ...................................................................................................999

169. Hypophosphatasia ............................................................................................................... 1005

170. Osteogenesis Imperfecta ..................................................................................................... 1008

171. Short Rib-Polydactyly Syndrome .......................................................................................... 1015

172. Thanatophoric Dysplasia...................................................................................................... 1018

II. Extremity Malformations ............................................................................................................ 1027

173. Clubfoot .............................................................................................................................. 1027

174. Rockerbottom Foot ............................................................................................................. 1034

175. Sandal Gap Foot .................................................................................................................. 1037

176. Radial Ray Malformation ..................................................................................................... 1040

177. Clinodactyly ......................................................................................................................... 1047

178. Polydactyly .......................................................................................................................... 1050

179. Syndactyly ........................................................................................................................... 1057

180. Split Hand - Foot Malformation ........................................................................................... 1063

181. Arthrogryposis, Akinesia Sequence ...................................................................................... 1070

182. Proximal Focal Femoral Dysplasia ........................................................................................ 1079

Section 10 - Placenta, Membranes, and Umbilical Cord ....................................................................... 1086

I. Introduction and Overview........................................................................................................... 1086

183. Approach to the Placenta and Umbilical Cord ...................................................................... 1086

II. Placenta and Membrane Abnormalities....................................................................................... 1095

184. Placental Abruption ............................................................................................................. 1095

185. Placenta Previa .................................................................................................................... 1102

186. Vasa Previa .......................................................................................................................... 1109

187. Placenta Accreta Spectrum .................................................................................................. 1112

188. Placental Lake, Intervillous Thrombus .................................................................................. 1119

189. Succenturiate Lobe .............................................................................................................. 1126

190. Circumvallate Placenta ........................................................................................................ 1129

191. Marginal Cord Insertion ....................................................................................................... 1133

192. Velamentous Cord Insertion ................................................................................................ 1136

193. Chorioangioma .................................................................................................................... 1140

194. Placental Teratoma ............................................................................................................. 1146

195. Chorioamniotic Separation .................................................................................................. 1150

III. Umbilical Cord Abnormalities ..................................................................................................... 1153

196. Single Umbilical Artery ........................................................................................................ 1153

197. Umbilical Cord Cyst ............................................................................................................. 1161

198. Umbilical Vein Varix............................................................................................................. 1168

199. Umbilical Artery Aneurysm .................................................................................................. 1174

200. Persistent Right Umbilical Vein ............................................................................................ 1178

201. Umbilical Vessel Thrombosis ............................................................................................... 1181

Section 11 - Multiple Gestations ......................................................................................................... 1185

202. Approach to Multiple Gestations ............................................................................................. 1185

203. Dichorionic Diamniotic Twins .................................................................................................. 1190

204. Monochorionic Diamniotic Twins ............................................................................................ 1196

205. Monochorionic Monoamniotic Twins ...................................................................................... 1203

206. Discordant Twin Growth .......................................................................................................... 1209

207. Twin-Twin Transfusion Syndrome ............................................................................................ 1215

208. Twin Reversed Arterial Perfusion............................................................................................. 1221

209. Conjoined Twins ...................................................................................................................... 1227

210. Triplets and Beyond ................................................................................................................ 1233

211. Fetus-in-Fetu ........................................................................................................................... 1239

Section 12 - Aneuploidy ...................................................................................................................... 1245

212. Screening for Aneuploidy ........................................................................................................ 1245

213. Trisomy 21 .............................................................................................................................. 1251

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Diagnostic Imaging Obstetrics, 2nd Edition

214. Trisomy 18 .............................................................................................................................. 1261

215. Trisomy 13 .............................................................................................................................. 1271

216. Turner Syndrome .................................................................................................................... 1281

217. Triploidy .................................................................................................................................. 1288

Section 13 - Syndromes and Multisystem Disorders ............................................................................ 1295

218. 22Q11 Deletion Syndrome ...................................................................................................... 1295

219. Aicardi Syndrome .................................................................................................................... 1298

220. Amniotic Band Syndrome ........................................................................................................ 1304

221. Apert Syndrome ...................................................................................................................... 1311

222. Beckwith-Wiedemann Syndrome ............................................................................................ 1317

223. Carpenter Syndrome ............................................................................................................... 1323

224. CHARGE Syndrome .................................................................................................................. 1326

225. Cornelia De Lange Syndrome ................................................................................................... 1329

226. Cystic Fibrosis .......................................................................................................................... 1333

227. Diabetic Embryopathy ............................................................................................................. 1336

228. Fryns Syndrome ...................................................................................................................... 1342

229. Holt-Oram Syndrome .............................................................................................................. 1345

230. Joubert Syndrome ................................................................................................................... 1351

231. Meckel-Gruber Syndrome ....................................................................................................... 1354

232. Multiple Pterygium Syndromes ............................................................................................... 1360

233. Neu-Laxova Syndrome............................................................................................................. 1364

234. PHACES Syndrome................................................................................................................... 1367

235. Pfeiffer Syndrome ................................................................................................................... 1370

236. Pierre Robin Anomaly .............................................................................................................. 1376

237. Sirenomelia ............................................................................................................................. 1379

238. Smith-Lemli-Opitz Syndrome ................................................................................................... 1385

239. Tuberous Sclerosis................................................................................................................... 1392

240. VACTERL Association ............................................................................................................... 1398

241. Valproate Embryopathy .......................................................................................................... 1405

242. Warfarin Embryopathy ............................................................................................................ 1408

243. Walker-Warburg Syndrome ..................................................................................................... 1411

Section 14 - Infection .......................................................................................................................... 1414

244. Cytomegalovirus ..................................................................................................................... 1414

245. Parvovirus ............................................................................................................................... 1420

246. Toxoplasmosis ......................................................................................................................... 1424

247. Varicella .................................................................................................................................. 1426

Section 15 - Fluid, Growth, and Well-Being ......................................................................................... 1430

248. Approach to Fetal Well-Being .................................................................................................. 1430

249. Polyhydramnios ...................................................................................................................... 1438

250. Oligohydramnios ..................................................................................................................... 1445

251. Intrauterine Growth Restriction .............................................................................................. 1452

252. Macrosomia ............................................................................................................................ 1459

253. Hydrops .................................................................................................................................. 1462

254. Fetal Anemia ........................................................................................................................... 1469

Section 16 - Maternal Conditions in Pregnancy ................................................................................... 1476

I. Gestational Trophoblastic Disease ................................................................................................ 1476

255. Complete Hydatidiform Mole .............................................................................................. 1476

256. Invasive Mole ...................................................................................................................... 1483

257. Choriocarcinoma ................................................................................................................. 1486

II. Uterus ......................................................................................................................................... 1492

258. Incompetent Cervix ............................................................................................................. 1492

259. Myoma in Pregnancy ........................................................................................................... 1499

260. MüLlerian Duct Anomalies in Pregnancy .............................................................................. 1506

261. Synechiae ............................................................................................................................ 1513

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Diagnostic Imaging Obstetrics, 2nd Edition

262. Uterine Rupture .................................................................................................................. 1516

III. Ovary ......................................................................................................................................... 1523

263. Corpus Luteum Cyst............................................................................................................. 1523

264. Theca Lutein Cysts ............................................................................................................... 1526

265. Hyperstimulation Syndrome ................................................................................................ 1532

IV. Gastrointestinal and Genitourinary Tracts .................................................................................. 1539

266. Appendicitis in Pregnancy.................................................................................................... 1539

267. HELLP Syndrome ................................................................................................................. 1542

268. Maternal Hydronephrosis .................................................................................................... 1548

Section 17 - Postpartum Complications ............................................................................................... 1555

269. Retained Products of Conception ............................................................................................ 1555

270. Endometritis ........................................................................................................................... 1558

271. Bladder Flap Hematoma .......................................................................................................... 1561

272. Ovarian Vein Thrombosis ........................................................................................................ 1564

Index .................................................................................................................................................. 1571

0-9 .................................................................................................................................................. 1571

A ..................................................................................................................................................... 1571

B ..................................................................................................................................................... 1573

C ..................................................................................................................................................... 1576

D ..................................................................................................................................................... 1579

E ..................................................................................................................................................... 1581

F ..................................................................................................................................................... 1582

G..................................................................................................................................................... 1584

H..................................................................................................................................................... 1585

I ...................................................................................................................................................... 1588

J ...................................................................................................................................................... 1589

K ..................................................................................................................................................... 1589

L ..................................................................................................................................................... 1589

M .................................................................................................................................................... 1590

N..................................................................................................................................................... 1592

O..................................................................................................................................................... 1593

P ..................................................................................................................................................... 1594

Q .................................................................................................................................................... 1596

R ..................................................................................................................................................... 1596

S ..................................................................................................................................................... 1597

T ..................................................................................................................................................... 1600

U..................................................................................................................................................... 1602

V ..................................................................................................................................................... 1604

W.................................................................................................................................................... 1605

Y ..................................................................................................................................................... 1605

Z ..................................................................................................................................................... 1605



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Diagnostic Imaging Obstetrics, 2nd Edition



Diagnostic Imaging Obstetrics, 2nd Edition

Cover



Authors

Authors

Paula J. Woodward MD

Professor of Radiology

David G. Bragg, MD and Marcia R. Bragg Presidential Endowed

Chair in Oncologic Imaging

University of Utah School of Medicine

Salt Lake City, UT

Anne Kennedy MD

Professor of Radiology

Adjunct Professor of Obstetrics and Gynecology

Executive Vice Chair of Radiology

Co-Director of Maternal Fetal Diagnostic Center

University of Utah School of Medicine

Salt Lake City, UT

Roya Sohaey MD

Professor of Radiology

Professor of Obstetrics and Gynecology

Director of Ultrasound

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Diagnostic Imaging Obstetrics, 2nd Edition

Oregon Health and Science University

Portland, OR

Janice L. B. Byrne MD

Associate Professor of Obstetrics and

Gynecology/Maternal-Fetal Medicine

Adjunct Associate Professor of Pediatrics/Medical Genetics

Director of Fetal-Neonatal Treatment Program

University of Utah School of Medicine

Salt Lake City, UT

Karen Y. Oh MD

Associate Professor of Radiology

Associate Professor of Obstetrics and Gynecology

Director of Breast Imaging

Oregon Health and Science University

Portland, OR

Michael D. Puchalski MD

Associate Professor of Pediatrics

Adjunct Associate Professor of Radiology

Director of Noninvasive Imaging

University of Utah School of Medicine

Salt Lake City, UT

Thomas C. Winter III MD

Professor of Radiology

Adjunct Professor of Obstetrics and Gynecology

Director of Body Imaging

University of Utah School of Medicine

Salt Lake City, UT

Logan A. McLean MD

Neuroradiology Fellow

University of Utah School of Medicine

Salt Lake City, UT

Contributing Authors

Akram M. Shaaban, MBBCh

David Holznagel, MD

Nelangi Pinto, MD

Asha Sarma, BA

Nicole Winkler, MD

Marcia L. Feldkamp, PhD, PA

Antonio E. Frias, Jr., MD

Shawn E. Gurtcheff, MD, MS

Sonographers

Brooke Axberg, RDMS

Jeanne Baker, RDMS

Kara Bridges, RDMS

Jenny Burke, RDMS

Angie Crist, RDMS

Chelsea Day, RDMS

Porsche Fletcher, RDMS

Danielle Galbreath, RDMS

Kristina Gudonaviciute, RDMS

Pam Guy, RDMS

Deanna Hecker, RDMS

Adrian Lethbridge, RDMS

Naomi Maggio, RDMS

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Diagnostic Imaging Obstetrics, 2nd Edition

Johanna Meier, RDMS

April Nelson, RDMS

Sami Newman, RDMS

Christine Sahn, RDMS

Leticia Seals, RDMS

Joanna Semon, RDMS

Amber Tackett, RDMS

Fariba Tehranchi, RDMS

Catherine Townsend, RDMS

Kasey Zimmer-Stucky, RDMS



Dedication

To Robert, Melanie, and Keri.

Family need not be defined by biologic fate but by the choices of loving bonds that we make.

To Anne and Roya (also my family) and my intrepid group of authors—my team—my friends. You bring joy

to the process.

PJW

To “we three”—the blonde, the brunette, and the redhead. Friends and adventurers forever.

AK

To Dave, Brett, and Haley. I am eternally grateful for your support and spirit. You bring me such joy and

mean everything to me. Also, to the original pioneers, Minoo and Manu, for emigrating to the U.S. so I

could “live the dream.”

RS

To Jerry, my husband and best friend of over 30 years, and my terrific son, Matt, without whose love and

understanding of my frequent prolonged absences, I would not be able to do what I do.

To all our wonderful patients, who often in times of great sorrow, graciously gave me permission to

photograph their children.

J LB B

To my husband, Antonio, for being my biggest fan at home and at work, and to our amazing children, Nina

and Diego, who make our family whole and provide endless entertainment.

KYO

To my parents who guided me with a soft but firm hand. The person I am today is because of them. To my

wife, Brenda, and my children, Luli and Tristan—you are the light of my life.

MDP



Preface

Here we go again!

We were so happy with the 1st edition of Diagnostic Imaging: Obstetrics that I couldn't imagine what we

would do in a 2nd edition. But that was 5 long years ago, and much has changed. Imaging has advanced,

new treatment regimens have been implemented, and our understanding of the pathophysiology and

genetics of many congenital diseases has changed. It is a never-ending, exciting journey in which those of

us in fetal imaging are immersed. It was with this excitement that we began to discuss what we wanted to

include in a 2nd edition.

The style of the 1st edition was extremely successful with its succinct, bulleted text yielding more “pearls

per pound” than standard textbooks. We did not want to “mess with success,” so the basic layout remains

the same—but with much, much more.

 New embryology chapters delineate normal fetal development, laying the basis for understanding

developmental anomalies. Each chapter contains detailed labeling of graphics and the normal fetal

structures seen on both ultrasound and MRI.

 New prose introductions exist for the major sections of the book. Our goal was to give the reader a

detailed approach to the abnormal fetus. Each introductory chapter sets up a framework for the

individual diagnoses that follow.



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