This document contains 33 figures showing ultrasound images of various fetal abnormalities and normal anatomy. The images depict a range of conditions affecting the brain, heart, abdomen, kidneys, limbs and other areas. Captions provide brief descriptions of the images and any relevant clinical information. The purpose is to illustrate various pathologies that can be identified on prenatal ultrasound exams.

1. 33
THE MALE GENITILIA AND
URETHRA
DAVID SUTTON

2. DAVID SUTTON PICTURES
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • Fig. 33.1 Two gestational sacs, each
containing a yolk sac: transvaginal image.

4. • Fig. 33.2 Profile face and upper thorax, early
second trimester.

5. • Fig. 33.3 Epignathus: corona) is showing soft-
tissue mass (arrows) mage through the face
bulging from mouth. 1 8 week gestation. 0 =
orbits.

6. • Fig. 33.4 Crown—rump lengths, with
measurements on TVS of: 8 mm, corresponding
to a gestational age of 7 weeks (A); 31 mm,
corresponding to a gestational age of 10 weeks
(B).

7. • Fig. 33.5 The measurement of the biparietal
diameter (leading edge to leading edge). csp =
cavum septum pellucidum; tv = third ventricle,
T = thalamus.

8. • Fig. 33.6 I mage oblique to transverse axial
plane. B = brainstem; C = cerebellum.

9. • Fig. 33.7 Transverse image through skull base.
A = anterior cranial fossa; M = middle cranial
fossa; C = cerebellum; cm = cisterna magna.

10. • Fig. 33.8 Transverse image near vertex. The
arrows delineate bright lines originally
thought to be the ventricular wall but now
accepted as venous structures in the
periventricular white matter.

11. • Fig. 33.9 (A) An appropriate level for measurement of
the abdominal circumference: transverse image in a
second trimester fetus. S = spine; STOM = stomach; P.V.
= portal vein. (B) Longitudinal image through abdomen
showing oblique course of portal vein through the liver
(arrows). Measurement of the abdominal
circumference from a section in the same plane as the
portal vein will give a falsely elevated value.

12. • Fig. 33.10 Normal femur. Length of shaft
(arrows). bl = fetal bladder.

13. • Fig. 33.11 (A) 42 week gestational sac (S)
measuring 3 mm in diameter. Note the eccentric
position in relation to the endometrium (E). (B) A
magnified image, again demonstrating the
gestational sac, demarcated by cursors.

14. • Fig. 33.12 A normal 6-week embryo (cursors).
Note the adjacent yolk sac and thick
echogenic ring of the normal gestational sac.

15. • Fig. 33.13 (A) A normal intrauterine pregnancy:
longitudinal image showing double decidual sac
sign (arrows). YS = yolk sac; BL = bladder. (B) First
trimester gestational sac. (Reproduced from
Nyberg et al 1983).

16. • Fig. 33.14 (A) Pseudogestational sac (arrows):
longitudinal image in a patient with an ectopic
gestation. M = myometrium. (B)
Pseudogestational sac. (Reproduced from Nyberg
et al 1983).

17. • Fig. 33.15 Normal 10-week fetus with a
crown-rump length of 32 mm. H=head,
B=body, YS= yolk sac.

18. • Fig. 33.16 A missed abortion. The rather
amorphous embryo is marked by cursors. No
fetal heart identified. Sonographic age 7 weeks,
compared with a menstrual age of 10 weeks.

19. • Fig. 33.17 Blighted ovum: transvaginal image
showing empty gestational sac measuring 2.6
cm in length. No fetal pole or yolk sac
identified. The menstrual age was 12 weeks.

20. • Fig. 33.18 A small gestational sac containing an
embryo with beating heart. The menstrual age
was 6 weeks 6 days and the crown–rump length
was in agreement with this. Three days later
there was a complete spontaneous abortion.

21. • Fig. 33.19 An irregular gestational sac (S) with
weak decidual reaction and embryonic
remnants (cursors). No fetal heart identified.
The menstrual age was 12 weeks.

22. • Fig. 33.20 Thickened amniotic membrane. A 2
mm fetal pole (F) was identified in this
pregnancy with a menstrual age of 12 weeks.
No fetal heart identified.

23. • Fig. 33.21 Ectopic pregnancy noted in the right
adnexa at a menstrual age of 7 weeks 3 days. A
beating heart was noted in the embryo (E) and a
yolk sac (Y) was present. There was surrounding
haematoma.

24. • Fig. 33.22 Ectopic pregnancy. A complex adnexal
mass (M) in a patient found at surgery to have a
ruptured fallopian tube. The ovary (0) containing
follicles (F) is seen adjacent to the mass.

25. • Fig. 33.23 A normal 10 week fetus. This
corona) image of the face shows the orbits
(o), maxilla and mandible (m).

26. • Fig. 33.24 A normal fetus with a menstrual
age of 8 weeks 3 days. The parallel echogenic
lines of the developing spine (S) can be seen.

27. • Fig. 33.25 Oblique coronal images: cervical
(A) and lumbar (B) spines. 0 = occiput; S =
intact skin surface; st = nuchal soft tissues; sc
= spinal cord.

28. • Fig. 33.26 Transverse images. (A) Lumbar spine
with three ossification centres forming a
complete 'ring' (large arrows) in a third-trimester
fetus. The two kidneys are seen on either side. (B)
Lumbosacral junction. LW = iliac wings; A = lower
abdomen.

29. • Fig. 33.27 (A,B) Anencephaly in two fetuses
showing prominent orbits (arrows) and an
absence of cerebral tissue more cranially.

30. • Fig. 33.28 Encephalocele (small arrows) with
visible sulci. D = calvarial defect.

31. • Fig. 33.29 Cervicothoracic myelomeningocele:
longitudinal (A) and transverse (B) images
with grossly abnormal distal spine (C, arrows).
(D) Equivalent radiograph.

32. • Fig. 33.29 Cervicothoracic myelomeningocele:
longitudinal (A) and transverse (B) images
with grossly abnormal distal spine (C, arrows).
(D) Equivalent radiograph.

33. • Fig. 33.30 Spina bifida with defects in the
cervical (C), thoracic (T) and lumbar (L) spines.
Longitudinal (A) and magnified (B) images.

34. • Fig. 33.31 Cervical spina bifida: longitudinal
(A) and transverse (B) images. Note the 'V'
shape rather than the normal 'ring' of
ossification centres on the transverse image.

35. • Fig. 33.32 Meningocele: transverse image. S =
sac containing only fluid; poc = splaying of the
posterior ossification centres.

36. • Fig. 33.33 Meningomyelocele: transverse
image. Short arrows = sac containing neural
elements; poc = splaying of the posterior
ossification centres.

37. • Fig. 33.34 The 'lemon sign'. There is flattening
of the frontal bones (arrows) on this
transverse image through the head.

38. • Fig. 33.35 The 'banana sign'. Note the
cerebellum (arrows) stretched around the
brainstem (B) with effacement of the cisterna
magna.

39. • Fig. 33.36 Ventriculomegaly: transverse image
through fetal head. a/b = lateral ventricular
ratio.

40. • Fig. 33.37 One of bilateral choroid plexus
cysts (cursors), measuring 13 x 8 mm. There
were additional forearm abnormalities and a
small cystic hygroma in this fetus, which
karyotyping showed to be a trisomy 18.

41. • Fig. 33.38 Dandy–Walker syndrome. The
posterior fossa cyst measures 1 2 x 9 mm in this
fetus with a gestational age of 19 weeks. A
hypoplastic cerebellum was identified and there
was also ventriculomegaly with a ventricular
atrium measuring 14 mm across.

42. • Fig. 33.39 Alobar holoprosencephaly: coronal
(A) and transverse (B) images. T = fused
thalami; MV = mono ventricle; arrows =
cortical mantle.

43. • Fig. 33.40 Semilobar holoprosencephaly:
transverse image. MV= monoventricle; small
arrows = anterior cortex with no interhemispheric
fissure; large arrow = posterior falx. On this image
there is no distinction from the alobar form.

44. • Fig. 33.41 Hydranencephaly: sagittal (A), anterior coronal (B),
transverse (C) and posterior coronal (D) images. Note the
brainstem surrounded by fluid (arrows, A,B) and an absence of
cerebral cortex. In (D) the tentorium (small arrows) can be seen
above a normal posterior fossa. c = cervical spine.

45. • Fig. 33.41 Hydranencephaly: sagittal (A),
anterior coronal (B), transverse (C) and posterior
coronal (D) images. Note the brainstem
surrounded by fluid (arrows, A,B) and an
absence of cerebral cortex. In (D) the tentorium
(small arrows) can be seen above a normal
posterior fossa. c = cervical spine.

46. • Fig. 33.42 Fetal heart: subcostal four-chamber
image. S = spine; ra = right atrium; la = left
atrium; ry = right ventricle with moderator
band; Iv = left ventricle.

47. • Fig. 33.43 Cardiac rhabdomyoma (R) in a 33
week fetus: oblique (A) and transverse (B)
images. The tumour measured approximately
4 cm in diameter. Note small pericardial
effusion (arrows).

48. • Fig. 33.44 Hydrops fetalis, transverse image. P
= pleural effusions; H = heart; SP = spine.

49. • Fig. 33.45 Hypoplastic chest in a fetus with
multiple abnormalities including
hydrocephalus and short limbs. C = chest; A =
abdomen (with ascites).

50. • Fig. 33.46 Diaphragmatic hernia: transverse
(A) and longitudinal (B) images. S = stomach,
herniated into chest; H = heart; arrows –
hypoechoic diaphragm. Note the
polyhydramnios.

51. • Fig. 33.47 Pulmonary sequestration:
longitudinal (A) and transverse (B) images. M
= hyperechoic mass lying at left lung base.

52. • Fig. 33.48 Cystic hygroma: longitudinal image.
H = head; C = small cystic lesion in
occipitocervical region. Despite the relatively
small size of this hygroma it was associated
with extensive lymphoedema.

53. • Fig. 33.49 Cystic hygroma: transverse image.
H = head; C = large ocipitocervical cysts with a
prominent midline septation (arrows)
corresponding to the ligamentum nuchae.

54. • Fig. 33.50 Extensive lymphoedema (arrows)
in a patient with a cystic hygroma: coronal
image. OR = orbits.

55. • Fig. 33.51 Hydrops fetalis: transverse image
through abdomen. L = liver; A = ascites.

56. • Fig. 33.52 Normal abdomen: transverse
image in third trimester. ST = stomach; SP =
spleen; S = spine; L = liver; a = aorta; ivc = IVC;
pv = portal vein.

57. • Fig. 33.53 Duodenal atresia: longitudinal (A)
and transverse (B) images. (C) Postnatal
radiograph. S = stomach; D = duodenum.
Note the 'double bubble' in (B) and
coexistent polyhydramnios.

58. • Fig. 33.54 Meconium peritonitis: longitudinal
(A) and magnified (B) images. BL = bladder; C
= cyst; small arrows = echogenic focus with
distal shadowing.

59. • Fig. 33.55 Omphalocele: longitudinal image. L
= herniated liver; PV = portal vein; CI = cord
insertion; S = spine.

60. • Fig. 33.56 Gastroschisis, showing bowel loops
floating freely within the amniotic fluid.

61. • Fig. 33.57 Normal kidneys, transverse images: early
second trimester (A) and late third trimester (B). K =
kidney; p = normal renal pelvis, measuring less than 10
mm in diameter; S = spine.

62. • Fig. 33.58 Polycystic kidneys, Potter type I,
longitudinal image. K = large hyperechoic
kidneys; C = hypoplastic chest. Note
oligohydramnios.

63. • Fig. 33.59 (A-D) The spectrum of multicystic dysplastic
kidneys, Potter type ff: all are transverse images except (D),
which is longitudinal. (A) Small cysts scattered throughout
both kidneys. (B) A mixture of small and large cysts in both
kidneys, right kidney arrowed. (C) Unilateral involvement
with a large multicystic mass. The contralateral kidney was
normal. (D) Unilateral involvement with small, peripheral
cysts. All cases demonstrated oligohydramnios. SP = spine;
c = cyst.

64. • Fig. 33.59 (A-D) The spectrum of multicystic dysplastic kidneys,
Potter type ff: all are transverse images except (D), which is
longitudinal. (A) Small cysts scattered throughout both kidneys. (B)
A mixture of small and large cysts in both kidneys, right kidney
arrowed. (C) Unilateral involvement with a large multicystic mass.
The contralateral kidney was normal. (D) Unilateral involvement
with small, peripheral cysts. All cases demonstrated
oligohydramnios. SP = spine; c = cyst.

65. • Fig. 33.60 Posterior urethral valves:
transverse images through hydronephrotic
kidneys (A) and more caudally (B). SP = spine;
u = dilated ureters; BL = distended bladder. L
denotes left side of fetus.

66. • Fig. 33.61 Prune-belly syndrome: longitudinal
image (A) and transverse image (B). BL =
distended bladder; arrows (A) = dilated
posterior urethra; arrows (B) = compressed
kidneys.

67. • Fig. 33.62 Forearm
abnormalities. (A)
Persistent wrist flexion in
both arms. This fetus with
trisomy 18 also had a
cystic hygroma and
bilateral choroid plexus
cysts. A = abdomen. (B)
Absent radius and ulna,
the hand being inserted
onto the distal humerus
(H ). This fetus also had
trisomy 18. Coexistent
pleural effusions were
noted. R = rib cage.

68. • Fig. 33.63 Sacrococcygeal
teratoma: longitudinal
(A) and transverse (B)
images. CT = cystic
teratoma at lower end of
spine; f and E = intra- and
extrapelvic components
respectively; arrows =
pelvic bones.

69. • Fig. 33.64 Conjoined twins (F) joined at the
chest and abdomen and sharing a common
heart (thoraco-omphalopagus).

70. • Fig. 33.65 Twin pregnancy with a menstrual
age of 8 weeks. Two sacs are seen, each
surrounded by an echogenic ring of chorion
and containing a live embryo. This is therefore
a dichorionic gestation.

71. • Fig. 33.66 F = fetus; P = placenta. (A)
Haemorrhage in both a retroplacental and
subchorionic distribution. rh = recent
haemorrhage; oh = old haemorrhage. (B)
Marginal abruption (arrows). Note yolk sac at
caudal end of fetus.

72. • Fig. 33.67 F = fetus; A = amniotic fluid. (A)
Subchorionic haemorrhage (arrows). (B)
Amnion–chorion separation (arrows).

73. • Fig. 33.68 (A) Multiple hypoechoic placental
infarcts (arrows) in a patient with a systemic
vasculitis. F = fetus. (B) Sonographic Spalding's
sign following fetal death; same patient as in
(A).

74. • Fig. 33.69 Cervical fibroid (arrows) measuring
4 cm in length, longitudinal image. F = fetus;
BL = bladder.

75. • Fig. 33.70 Cervical incompetence.
Longitudinal image showing cervical
effacement. FL = fetal limbs; BL = bladder;
arrows = vagina.

76. • Fig. 33.71 Agenesis of the corpus callosum diagnosed inutero
using a single-shot fast spin echo sequence, on a 1.5T scanner, (A)
sagittal and (B) coronal plane through the fetal head at 23 weeks
gestation (the corpus callosum forms between 8 and 20 weeks
gestation). The absent corpus callosum is arrowed in A. In B there is
a high-riding third ventricle and crescentic lateral ventricles
(arrowed) compressed by Probst bundles. (Courtesy of Professor
Paul Griffiths, Sheffield)