Dr John Campbell
Past President,
Royal Australian College of Obstetricians and Gynaecologists
Medicolegal Advisor, Avant Insurance Limited
www.avant.org.au

50 video clips of fetal malformation sequences will be presented. These lesions will be presented in order of likelihood of litigation and order of frequency of occurrence in clinical practice.

50 video clips sequences which may lead the clinician to both false negative and false positive diagnoses will be presented.  Examples across all organ systems will be demonstrated.  Practical clues on how to minimize these errors in diagnosis will be outlined.

A systematic approach to the fetal heart examination.

1. SARRS
2. Four Chamber view of Heart
3. Five Chamber view of Heart
4. Three Vessel View 
5. Three Vessel Tracheal View
6. Ductal and Aortic Arches
7. Venous Drainage

Ultrasound system optimization for the fetal cardiac examination:  Frequency.  Sector width.  Depth.  Zoom.  Focal zone.  Dynamic range.  Harmonics.  Compound imaging.  Speckle Reduction.  Cine loop.  Program settings.  Individualize settings.
10 mins
Optimization of colour and pulsed Doppler settings- 5 mins.
ISUOG guidelines for cardiac examination- 10-15 mins  

Video clip sequences of the following structures will be presented.  Stomach, Aorta  IVC, Situs, Axis rotation, rate, rhythm, size of heart.  Ventricle sizes.  Moderator Band.  Contractility.  Which ventricle forms the apex.  AV Valve alignment.  AV valve movement.  Septal attachment of the tricuspid valve.  Atrium Primum.  Ovale.  Secundum.  Atrial Sizes.  Pulmonary Veins.  Number of vessels behind the left atrium. Pericardial space.  Coronary Sinus.  Azygous Vein.  Azygous Arch.  5 chamber.  Continuity of anterior wall of the Aorta with IVS.  Ascending Aorta-dilatation/ballooning.  RVOFT.  Pulmonary artery.  Pulmonary valve.  RPA & LPA.  Ductus arteriosus.  Crossing over of the major vessels.  Caliber of the PA to Aorta compared.  Aortic Arch Neck vessels (BC. LCC, LS).  Ductal arch.  SVC and IVC entering RA.  Eustachian valve.  Confluence Right Hepatic vein, DV, and IVCI Intra-hepatic vein-’J-hook’ Iinominate Vein Main Bronchi - 3 vessel versus 3 vessel tracheal view

120 video clips of cardiac abnormalities observed on the 4-chamber view will be  presented.  The following anomalies will be presented in a question and answer format.  They will not be presented in order but rather randomly presented as occurs in clinical practice. ( A Cook).

Ventricular Septal defects.  Perimembraneous type.  Muscular type.  Atrial septal defects.  Primum type. Secundum.  Sinus venosus.  Atrio-ventricular septal defects.  Differential diagnosis.  Tricuspid valve Anomalies.  Ebsteins Anomaly.  Tricuspid Dysplasia.  Mitral Atresia.  Hypoplastic left heart Syndrome. Hypoplastic right heart.  Hypertrophic Cardiomypoathy.  Dilated Cardiomypoathy.  Intracardiac Echogenic Focii.  Cardiac Tumours.  Pericardial effusion.  Absent Ductus Venosus.  Cardiac extrophy.  Foramen Ovale.  Aneurysm.  Reversal of Ovale Flap.  Situs Anomalies.  Situs Solitus.  Situs Inversus.  Left atrial isomerism.  Right atrial isomerism.  Dextroposition.  Isolated Dextrocardia.  Atrio-Ventricular Discordance. Dilated Coronary Sinus.  Di George syndrome.

120 video clips of cardiac abnormalities observed on the 4-chamber view will be  presented.  The following anomalies will be presented in a question and answer format.  They will not be presented in order but rather randomly presented as occurs in clinical practice. ( A Cook).

Ventricular Septal defects.  Perimembraneous type.  Muscular type.  Atrial septal defects.  Primum type. Secundum.  Sinus venosus.  Atrio-ventricular septal defects.  Differential diagnosis.  Tricuspid valve Anomalies.  Ebsteins Anomaly.  Tricuspid Dysplasia.  Mitral Atresia.  Hypoplastic left heart Syndrome. Hypoplastic right heart.  Hypertrophic Cardiomypoathy.  Dilated Cardiomypoathy.  Intracardiac Echogenic Focii.  Cardiac Tumours.  Pericardial effusion.  Absent Ductus Venosus.  Cardiac extrophy.  Foramen Ovale.  Aneurysm.  Reversal of Ovale Flap.  Situs Anomalies.  Situs Solitus.  Situs Inversus.  Left atrial isomerism.  Right atrial isomerism.  Dextroposition.  Isolated Dextrocardia.  Atrio-Ventricular Discordance. Dilated Coronary Sinus.  Di George syndrome.

1) 5-chamber view anomalies
2) 3-vessels view anomalies 
3) 3-vessel tracheal view anomalies

Video clip sequences of the following abnormalities will be presented:

Tetralogy of Fallot. Transposition of the great arteries. Simple TGA. TGA with VSD. Congenitally corrected transposition of the great vessels. Truncus arteriosis. Double outlet right ventricle. Double inlet left ventricle. Pulmonary stenosis. Pulmonary atresia with intact IVS. Aortic stenosis. Critical aortic stenosis.

1) 5-chamber view anomalies
2) 3-vessels view anomalies 
3) 3-vessel tracheal view anomalies

Video clip sequences of the following abnormalities will be presented:

Interrupted aortic arch. Coarctation of the Aorta. Right side aortic arch. Double aortic Arch. Persistent left IVC. Aberrant right subclavian artery. Absent pulmonary valve syndrome. CCTGA with Ebsteins. DORV with transposed vessels. Dilated SVC – TAPVR, IUGR.

The subject matter of this article will be presented (click here). The benefits and limitations of first trimester fetal cardiac examination will be outlined. 70 video clips of first trimester fetal anomalies will be presented.

 

Dr Michelle Fink
BSc MB BChir MRCP FRCR FRANZCR
Paediatric Radiologist
Royal Children's Hospital

Examination of the Normal fetal Brain. Midline falx. How cerebral peduncles may be distinguished from the thalami. Lateral ventricle measurement. Choroid separation. Cerebellum diameter - At what measurement should the question of DWM or cererbellar hypoplasia be raised? Cisterna Magna. Blakes pouch. Roof of the Rhombencephalon. Importance of the Sylvian fissure. Circle of Willis. MCA measurement - Accepted methods. Superior sagittal Sinus. Corpus Callosum evaluation. 3D - assessment of the Fetal Brain. 

200 video clip sequences of fetal brain malformation.

Cavum septum pellucidum. Cavum Vergae. Cavum interpositium. Isolated ventriculomegaly. Fetal Infection. Agenesis of the corpus callosum. Aqueduct stenosis. Holpoprosencephaly. Dandy - Walker Malformation. Dandy - Walker variant. Mega cisterna magna. Blakes pouch. Retrocerebellar cyst. Rhombencephalosynapsis. Microcephaly. Macrocrania. Scaphocephaly. Acro (Turri) cephaly. Hypomineralisation. Hemimegalencephaly. Lissencephaly. Schizencephaly. Hydrancephaly. Porencephaly. Acrania. Cephalocele. Encephalocele. Diastomatomyelia. Sacrococcygeal teratoma. Hemi-vertibrae. CPC’s. Interhemispheric cysts. Neural Tube defects.

30 ectopic pregnancies from 5mm à 50mm in size will be presented. Sonographic approach to diagnosis. The rule of ‘4’. Decidual change - a clue to diagnosis? Is ectopic vascularity useful? Benign versus aggressive ectopic pregnancies - sonographic clues which guide treatment options. Cornual ectopic pregnancy. Cervical ectopic pregnancy. Ovarian ectopic pregnancy. Intra-myometrial ectopic pregnancy. Caesarean scar ectopic pregnancy.

Saline Sonohysterography. Proliferative endometrium. Secretory endometrium. Hyperplasia. Polyp formation. 3D assessment of endometrial abnormalities. PMB - endometrial diagnosis. What thickness should be used as the cut off in symptomatic and asymptomatic post menopausal patients. Tamoxifen induced change. Endometrial cancer. Types of IUCD. Displaced IUCD. IUD migration. RPOC. A-V Malformation. Sub endometrial cysts.

Guidelines in assessing pregnancy failure. Medicolegal implications of incorrect diagnoses. ASUM recommendations. When is a pregnancy Failed? What is the significance of perigestational haemorrhage? What is the significance of a low gestation sac? How do you define embryonic bradycardia? What role does the yolk sac play in predicting pregnancy success or failure? What is the significance of a dilated yolk sac, irregular yolk sac, absent yolk sac. Eccentric pregnancy - ?significance. Should you report a gestation sac that is small or enlarged? Decidual reaction - Does this play a role? Intra-amniotic haemorrhage - ?significance. Adnexa - Activity of corpus luteum? Relevance.

Definition of a leading follicle. Definition of a simple cyst. PCO. Haemorrhagic cysts. Haemorrhagic corpora lutea. Endometriosis. Dermoids. Dermoid variations. Serous cystadenomas. Mucinous cystademonas. Fibromas. Thecomas. Granulosa cell tumours. Sertoli -Leidig tumours. Borderline ovarian tumours. Ovarian torsion. Sonographic approach to Ovarian cancer Stages I-IV. Role of Doppler assessment. Fallopian tube anomalies. Hyrosalpinx. Haematosalpinx. Loculated pelvic fluid. Pelvic abscess. PID. Appencicular masses. Sacral neuromas. Bowel cancer. Inflammatory bowel disease.