The sonographic differentiation between hydranencephaly, severe hydrocephalus, and holoprosencephaly can be difficult. Careful examination of cranial anatomy has proven quite useful in differentiating these three anomalies. The presence or absence of a complete midline falx, cortical tissue, facial and cardiac anomalies, internal carotid arteries, and fetal circle of Willis is useful in providing accurate diagnoses. This case reports a failure to recognize hydrocephalus despite the presence of well-established identifiers.
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