Fig. 2

A 34-year-old female 28 weeks pregnant underwent a routine 4D US revealing multiple fetal anomalies. Ultrasound findings: A Axial trans-abdominal image of the fetal pelvis, B sagittal transvaginal image of fetal abdomen and pelvis shows the dilated sigmoid colon and rectum down to the level of the anorectal junction with absent echogenic anal dimple and multiple echogenic intra-luminal well-defined lesions (enterolith). A The image also shows a well-defined cystic structure posterior to the dilated rectum with a thin echogenic wall. C Axial trans-abdominal image of fetal neck revealing subcutaneous cystic lesion in the fetal nape with communication with a bony defect in the occipital bone. Fetal MRI findings: D, E, F, G axial, coronal, sagittal, and coronal T2WIs, respectively, revealed dilated rectum, sigmoid, and descending colon with multiple enteroliths (arrowed) within (low T2 signals oval structures) and detected narrowed rectal segment below the apex of the bladder (low type). D The axial image revealed a low T2 signals of a cystic lesion (arrowed) posterior to the rectum (denoting calcification). G Coronal T2WIs revealed smooth fetal perineum with an absent anal dimple. F The sagittal image revealed the occipital cystic lesion. Combined US and MRI Diagnosis: Low-type anorectal malformation with recto-vesical fistula, meconium pseudocyst, and occipital encephalocele likely representing sequel of VACTERL anomaly. IUFD at GA 29 weeks