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Chapters 14 & 15

Esophageal Atresia

Discontinuity of the esophagus.

What is Esophageal Atresia accompanied by 90% of the time?

Distal tracheo-esophageal fistula

Congenital malformations associated with esophageal atresia:

cardiovascular, gastrointestinal, gastrourinary, muskuloskeletal anomalies

Meconium (mixture of:)

Bile, swallowed vernix, desquamated cells, and fetal hair

When is the colon most obvious?

3rd trimester

Peristalsis can be seen by:

Late 2nd trimester

Sonographic findings of esophageal atresia:

small or absent stomach, inability to demonstrate stomach on serial exams, polyhydramnios

Duodenal Atresia

The first part of the small bowel (duodenum) hasn't developed properly.

Anomalies associated with duodenal atresia:

Karyotype, or anomalies present at birth. Most commonly cardiac or vertebral. Trisomy 21.

Sonographic findings of duodenal atresia:

"double bubble" sign, polyhydramnios

"Double Bubble" sign

dilated stomach and dilated proximal duodenum

Duodenal atresia may not become apparent until:

24 weeks gestation

Intestinal Atresia

Narrowing, absence, or obstruction of the intestine. (w/ subsequent distention of bowel loops)

Intestinal Atresia - The small bowel internal diameter is:


Intestinal Atresia - Sono - PAC PIM

P - polyhydramnios
A - ascites
C - calcifications

P - perforation,
I - increased peristalsis,
M - multiple fluid filled bowel.

Meconium Peritonitis

Rupture of the bowel prior to birth. (perforation in utero)
Results in fetal stool (meconium) escaping into the peritoneum.
Leads to peritonitis. (sterile chemical peritonitis)

Etiology of Meconium Peritonitis:

Cystic Fibrosis (35-40%)
Because of thick, sticky meconium

Meconium Peritonitis can occur after:

Fetal bowel obstruction.

Fetal bowel obstruction can be caused by:

Intestinal atresia, volvulus, or meconium ileus.

Meconium Peritonitis - sono - CAMP

C - calcifications in fetal abdomen
A - ascites
M - meconium pseudocyst
P - polyhydramnios.

Hyperechoic Bowel

The echogenicity is increased and is similar to or greater than the adjacent bone.

Hyperechoic Bowel cant be identified until:

2nd trimester

Hyperechoic Bowel is located in:

Lower fetal abdomen and pelvis

Hyperechoic Bowel characteristics:

Focal or diffuse, doesn't shadow

What should be used to determine Hyperechoic Bowel?

Lower frequency.

Etiologies of Hyperechoic Bowel: STINC

S - swallowed intra-abdominal blood (rare)
T - trisomy 21
I - infection - CMV (cytomegalovirus)
N - normal variant
C - cystic fibrosis

What plane can you see the upper lip and nares?

Oblique coronal plane

What plane can you see the eyes?

True coronal or trans

What is associated with an absent or hypoplastic nasal bone?

Trisomy 21

Trisomy 21 is associated with a NF of:

>6mm (between 15 and 21 weeks)


Decreased intraorbital distance


Increased intraorbital distance

Hypotelorism associated with:

Holoprosencephaly, and other symptoms

Hypertelorism associated with:

Anterior cephalocele, and other symptoms

What is the most common congenital facial anomaly?

Cleft lip / Palate

Cleft lip/palate percentages:

25% cleft lip only
50% cleft lip and palate
25% cleft palate only

Asymmetric clefts can be associated with:

Amniotic band syndrome

Cleft lip/palate - sono - PB SAM

P - polyhydramnios
B - Best seen in coronal section

S - shouldn't be mistaken for philtrum
A - Anechoic cleft extending from nostril to lip
M - may see tongue moving in cleft

Median Cleft Lip

Midline malformation without cleft palate

Median cleft lip embryonic development is related to:

Differentiation of the forebrain

Median cleft lip associated with:

Holoprosencephaly, other ML defects of the face

Median cleft lip - sono:

Similar to cleft lip/palate
Search for other facial anomalies (face predicts the brain)


Abnormally small jaw

Micrognathis associated with:

Trisomy 18

Frontal Bossing

A prominent forehead due to absent nasal bridge

Frontal Bossing associated with:

Skeletal Dysplasia


Pharyngeal teratoma which protrudes from the fetal mouth.


Epignathus associated with:

Polyhydramnios (b/c ineffective fetal swallowing)

Epignathus - sono:

Large complex cystic and solid mass
May hyperextend the neck

Cystic Teratoma

Complex cystic or solid mass near the fetal neck

Can occur anywhere on or around the neck

Cystic Teratoma may be mistaken for:

Cystic Hygroma

Nuchal Thickening

Increased soft tissue thickness at the posterior aspect of the neck.

Nuchal Thickening associated with:

Trisomy 21, and other chromosomal anomalies

When looking for nuchal thickening, what else do you see in the oblique axial plane?

Cavum Septum Pellucidum
3rd Ventricle
Cisterna Magna

Nuchal Thickening - Abnormal Measurement:

>6mm (15-21 weeks)

Fetal head must NOT be hyperextended

Cystic Hygroma

Single or multiple cystic areas surround the neck.

Cystic Hygroma associated with: FAT TAP

F - fetal Hydrops (Large ones)
A - ascites
T - trisomy 21

T - turner's syndrome
A - anasarca
P - pleural effusion

The orgin of a cystic hygroma is:

Lymphatic system

Cystic Hygroma may mimic:

Cervical Teratoma
Cervical Meningomyelocele

Cystic Hygroma - sono:

Thin walled
Multiseptated mass
Nuchal ligament may be seen extending posterior.

What can be a cause of Polyhydramnios?

Inability for the fetus to swallow. (Fetus normally swallows amniotic fluid)

Anything causing more fetal urine output (Fetal urine is a major source of amniotic fluid)

Most things associated with GI anomalies (Trisomy 18 & 21)

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