Sonography

On an ultrasound, clubfoot (talipes equinovarus) can often be identified during the second trimester of pregnancy. The main features of clubfoot seen on an ultrasound include:
1. Foot Position: The foot appears abnormally rotated, with the sole of the foot turned inward toward the midline of the body. Sometimes, the bottom of the foot can be seen in the same plane as the shin, which is not typical.
2. Calf and Foot Alignment: The angle between the lower leg bones (tibia and fibula) and the foot appears irregular. This alignment abnormality shows the foot twisted inward, often compared to the appearance of a golf club shape.
3. Inability to See the Normal Foot Arch: Because the foot is turned inward, the normal contour of the arch is often not visible, or appears distorted.
4. Decreased Range of Motion: During a standard scan, the foot may not move in the usual way, which can be a clue for the sonographer.

1. Obstetric Sonography Overview

• Key Concepts: Gravidity and parity, establishing gestational age, and initial clinical assessment.
• Diagnostic Tips: Collect a thorough maternal history and be familiar with standard imaging protocols, especially for early pregnancy assessments.

2. The First Trimester

• Key Concepts: Embryonic and fetal development, including gestational sac, yolk sac, and fetal pole.
• Sonographic Signs: Gestational sac diameter, yolk sac size, and fetal heart rate are crucial markers of viability.
• Diagnostic Tips: Measure crown-rump length for dating, and identify early signs of abnormal pregnancies like blighted ovum or ectopic pregnancy.

3. The Fetal Head and Brain

• Key Concepts: Fetal brain anatomy and key measurements, including the biparietal diameter (BPD) and head circumference (HC).
• Sonographic Signs: Normal vs. abnormal brain structures, including ventriculomegaly and anencephaly.
• Diagnostic Tips: Focus on midline structures like the cavum septi pellucidi and cerebellum, as well as measuring lateral ventricles for early anomaly detection.

4. The Fetal Face and Neck

• Key Concepts: Facial structure assessment (nose, lips, orbits) and nuchal translucency (NT) measurement for chromosomal screening.
• Sonographic Signs: Abnormal NT, cleft lip/palate, and facial symmetry.
• Diagnostic Tips: Use NT measurement (in the first trimester) as a screening marker for Down syndrome and other aneuploidies.

5. The Fetal Spine and Musculoskeletal System

• Key Concepts: Normal spinal anatomy, limb length measurements, and musculoskeletal development.
• Sonographic Signs: Abnormalities like spina bifida, clubfoot, and limb abnormalities.
• Diagnostic Tips: Carefully scan in a sagittal plane to assess the spine, ensuring the skin line is intact to rule out neural tube defects.

6. The Fetal Heart and Chest

• Key Concepts: Anatomy of the fetal heart and major vessels, four-chamber view, and outflow tracts.
• Sonographic Signs: Congenital heart defects like hypoplastic left heart and transposition of the great arteries.
• Diagnostic Tips: Perform Doppler studies on cardiac vessels for detailed assessment, and use the three-vessel view to evaluate pulmonary arteries and aorta.

7. The Fetal Gastrointestinal System

• Key Concepts: Normal GI tract structures, such as the stomach, intestines, and abdominal wall.
• Sonographic Signs: Anomalies like gastroschisis, omphalocele, and echogenic bowel.
• Diagnostic Tips: Confirm normal stomach filling, and assess abdominal wall integrity to check for defects.

8. The Fetal Genitourinary System

• Key Concepts: Kidneys, bladder, and genitalia assessment.
• Sonographic Signs: Hydronephrosis, polycystic kidneys, and ambiguous genitalia.
• Diagnostic Tips: Ensure both kidneys and bladder are present and functional, and examine for any dilation indicating potential obstruction.

9. Chromosomal Abnormalities

• Key Concepts: Common chromosomal abnormalities (trisomy 21, 18, 13) and their markers.
• Sonographic Signs: Indicators like thickened nuchal fold, shortened femur, and absent nasal bone.
• Diagnostic Tips: Use nuchal fold and nasal bone assessment as part of a detailed second-trimester screening, in addition to biochemical tests if available.

10. Multiple Gestations

• Key Concepts: Chorionicity and amnionicity, twin-to-twin transfusion syndrome (TTTS).
• Sonographic Signs: Separate placentas or shared circulations, abnormal fluid levels, and growth discrepancies in twins.
• Diagnostic Tips: Identify number of amniotic sacs and placentas early on to determine chorionicity, and monitor for complications unique to multiple gestations.

11. Fetal Environment and Maternal Complications

• Key Concepts: Placental structure, amniotic fluid volume, and maternal complications like preeclampsia.
• Sonographic Signs: Abnormal placental attachment (e.g., placenta previa), placental abruption, and polyhydramnios/oligohydramnios.

• Diagnostic Tips: Measure amniotic fluid index (AFI) to assess fluid levels and monitor placental location throughout pregnancy.

Summary Tips for Studying Obstetric Sonography

• Understand Fetal Biometry: Familiarize yourself with standard measurements (BPD, HC, FL) and their importance in assessing fetal growth.
• Master Doppler Techniques: Use Doppler to assess blood flow in the umbilical artery, ductus venosus, and fetal heart to monitor fetal health.
• Recognize Common Anomalies: Review the sonographic features of conditions like cleft palate, omphalocele, and cardiac defects.
• Combine Sonography with Clinical Data: Be mindful of clinical history, maternal conditions, and lab results when interpreting sonographic findings.

• Appearance: Hypoechoic mass disrupting the normal cervical structure.
• Sonographic Signs: May show abnormal vascularity on Doppler.
• Diagnostic Tips: Evaluate for irregular cervical contour and Doppler flow patterns in suspected cases.

Summary Tips for Studying Gynecologic Lesions

• Use Sonographic Patterns: Recognize lesion types (e.g., cystic vs. solid) and their typical sonographic features.
• Combine Clinical Data: Symptoms, lab results, and Doppler findings help differentiate benign from malignant lesions.
• Review Key Diagnostic Techniques: Sonohysterography for endometrial pathology, Doppler for vascularity, and 3D imaging for complex structures.
• Memorize Common Signs: Such as the “string of pearls” for PCOS and “tip of the iceberg” for dermoid cysts.

Study Guide for Lesions in Gynecologic Sonography

1. Uterine Lesions

• Fibroids (Leiomyomas):
• Appearance: Hypoechoic or heterogeneous masses within the uterus; may be submucosal, intramural, or subserosal.
• Sonographic Signs: Shadowing due to dense tissue, potential calcifications, and variable vascularity on Doppler imaging.
• Diagnostic Tips: Look for well-defined, round masses; fibroids may distort the uterine contour.
• Adenomyosis:
• Appearance: Diffuse or focal thickening of the myometrium with tiny cystic spaces.
• Sonographic Signs: “Venetian blind” shadowing pattern, ill-defined margins, and a globular uterus.
• Diagnostic Tips: Differentiate from fibroids by looking for a more diffuse myometrial texture rather than discrete masses.
• Endometrial Hyperplasia and Polyps:
• Appearance: Thickened, heterogeneous endometrium, often with small cystic spaces.
• Sonographic Signs: Focal or diffuse endometrial thickening; polyps may show a vascular stalk on Doppler.
• Diagnostic Tips: Sonohysterography can help visualize and differentiate polyps from hyperplasia.

2. Ovarian Lesions

• Ovarian Cysts:
• Appearance: Anechoic, thin-walled, and round; usually show posterior acoustic enhancement.
• Types:
• Functional Cysts: Follicular and corpus luteum cysts, typically resolve on their own.
• Hemorrhagic Cysts: May show internal echoes or a “lace-like” pattern due to blood content.
• Diagnostic Tips: Assess for thin walls and no solid components in benign cysts.
• Polycystic Ovary Syndrome (PCOS):
• Appearance: Multiple small cysts arranged peripherally around the ovary, creating a “string of pearls” appearance.
• Sonographic Signs: Enlarged ovaries with increased stromal echogenicity.
• Diagnostic Tips: Combine with clinical criteria (e.g., irregular cycles, elevated androgen levels).
• Endometriomas:
• Appearance: “Ground-glass” echotexture due to blood content; often homogeneous.
• Sonographic Signs: Hypoechoic, thick-walled cyst with no internal septations.
• Diagnostic Tips: Endometriomas may not change size with the menstrual cycle, unlike functional cysts.
• Dermoid Cysts (Mature Cystic Teratomas):
• Appearance: Mixed echogenicity with complex cystic and solid components; may contain hair, fat, and calcifications.
• Sonographic Signs: “Tip of the iceberg” sign (dense mass obscuring deeper structures) or echogenic foci with shadowing.
• Diagnostic Tips: Check for echogenic areas indicating fat or calcifications.

3. Fallopian Tube Lesions

• Hydrosalpinx:
• Appearance: Dilated, fluid-filled fallopian tubes with anechoic or low-level internal echoes.
• Sonographic Signs: “Incomplete septa” or “beads on a string” appearance.
• Diagnostic Tips: Look for tubular shape adjacent to the ovary and note any peristaltic movement.
• Pyosalpinx:
• Appearance: Dilated fallopian tube with thick, echogenic fluid due to pus.
• Sonographic Signs: May appear more complex than hydrosalpinx with echogenic debris.
• Diagnostic Tips: Often associated with pelvic inflammatory disease (PID).
• Ectopic Pregnancy:
• Appearance: Extrauterine gestational sac with or without a yolk sac or fetal pole; often in the ampullary portion.
• Sonographic Signs: Complex adnexal mass and free fluid in the pelvis, possibly with echogenic clots.
• Diagnostic Tips: Correlate with a positive pregnancy test and absence of an intrauterine pregnancy.

4. Malignant Lesions

• Ovarian Cancer:
• Appearance: Solid or complex masses with irregular, thick walls and septations.
• Sonographic Signs: Doppler may reveal increased vascularity; ascites may be present.
• Diagnostic Tips: Look for papillary projections, thick septations, and solid areas within the mass.
• Endometrial Carcinoma:
• Appearance: Thickened, irregular endometrium; may involve the myometrium in advanced stages.
• Sonographic Signs: Poorly defined endometrial-myometrial junction; increased vascularity on Doppler.
• Diagnostic Tips: Suspect if endometrial thickness exceeds postmenopausal norms (e.g., >5mm).
• Cervical Cancer:

Renal pyelectasis. This has an increased incidence in Trisomy 21 fetuses. Would suggest further correlation with a quad screen and detailed genetic sonogram, with amniocentesis if indicated at that time.

What anomalies we can see in 11 weeks pregnancy?

Scanning Fun😄

Infant hip ultrasound

Ectopic pregnancy

Degenerative myoma