 I'm Dr. Paul Chedilin. I'm from the Department of Radiology, Government Medical College, Kodiput. The co-author is Dr. Jwena P. My topic is prenatal diagnosis of a case of D. George syndrome. Abstract, 22Q deletion syndrome or D. George syndrome is often diagnosed prenatally with cardiac and extracardial anomalies. A diagnosis should be considered. In all cases of prenatally diagnosed continual heart disease, particularly when it is associated with thymic hyperplasia. Fluorescence in situ hybridization or microarrays warranted in all cases of structural abnormalities with a diagnosed prenatally. The prenatal diagnosis and counseling is mandatory in expectant parents regarding pregnancy outcome and unit management. I'm reporting a case of D. George syndrome in a fetus and discussing the imaging features with genotypic correlation and post-mortem phenotypic follow-up. Introduction, D. George or 22Q-11 deletion syndrome is the most common human chromosome in micro deletion syndrome. It is caused by a developmental defect of the third and the fourth pharyngeal pouches and the fourth iotic arch. Craniofacial anomalies such as cleft palate, micrognathia, eye anomalies, et cetera, are seen. Conjunctinal heart disease, mainly conatrunkal anomalies are noted. An absent or a small thymus or an absent parathorot gland causing hypoxemia and immunodeficiency are found. Rarely, musculoskeletal anomalies are also seen. Case reporting, a 28-year-old primicravida, non-consanguineous marriage on a routine anomaly scan reveal a fetus of 20 weeks, three days gestation with normal interval growth and biometric. In the three vessel trachea view, the iotic arch was seen to the right of the trachea with left-sided ductus confirming a right-sided iotic arch. An aberrant vessel with arterial flow was found coursing behind the isophagus towards the left arm and was diagnosed to be an aberrant left subclavian artery. The three vessel view showed absence of thymus and anterior displacement of the great vessels. The thymic thoracic ratio was 0.14. Normally, it is 0.44. A bifiduvula was visualized in the level of the porofarus. This is a grayscale image showing pulmonary artery, trachea, and aorta. Normally, pulmonary artery and aorta is seen towards the left of the trachea, but here. Iotic arch is seen towards the right of the trachea, confirming it to be a right-sided iotic arch. This is a corresponding colored-upper image showing pulmonary artery, ductus arteriosus, iota and iotic arch, joining together to form the tracheal u-sign, which is seen dispositive to the trachea. This is a grayscale image showing a left-sided ductus arteriosus, which is seen to the left of the trachea, confirming it to be a left ductus arteriosus. This is another grayscale image at the left of the clavicle, showing a left sub-aburant subclavian artery, which is causing towards the left arm of the fetus, the normal right subclavian artery and iota, I see. This is an image showing the thymic thoracic ratio. This measurement is the AP diameter of the thymus, which is very small. The distance from the posterior aspect of the sternum to the anterior aspect of the iotic arch is measured. And another measure from the posterior aspect of the sternum to the anterior aspect of the vertebral body is taken. And these two measurements are divided to get the thymic thoracic ratio. It was on to be 0.14, which is way less than the normal measurement 0.44. Again, at the level of the oropharynx, you can see the alveolar ridge, the base of the tongue. And in a normal fetus, the classic equal to sign is noted confirming the presence of a normal uvula. But in our case, there was a double equal to sign confirming a bifiduvula at the level of the oropharynx. And amniocentesis with cytogenomic microwave analysis showed a loss involving chromosome 22 at cytoregene Q11.21, confirming it to be the George syndrome. This is an image showing deletion at the 22nd chromosome in a chromosomal microwave study. Fetal echo on the 23rd week of gestation confirmed the findings of right cell riotic arch, aberrant left subclavian artery, and absinthymus. The pregnancy was terminated before 24 weeks, and post-mortem examination of the abortus showed bifiduvula and absinthymus. These are the images showing a bifiduvula of the abortus and a grayscale image showing nabsinth or reduced times and a reduced timing thoracic ratio in the abortus. Discussion. Cardiovascular anomalies remain. The most striking sonotrophic feature suggests an underlying prenatal diagnosis of 22 Q11 syndrome. Most cases that are diagnosed prenatally have an abnormal fetal cardiac structure and typically constitutes conotruncal malformations, such as interrupted iodic arch type B, right-sided iodic arch, tetralogy of phallid, truncus arteriosus, and pulmonary atresia with BSD. On detecting these cardiac defects prenatally, 22 Q11 must be considered as a differential diagnosis and should be included in parental counseling. Absinth or hyperplastic thymus is best diagnosed using the three-vessel view. The fetal thymus is well-developed by this gestation age and can be identified on ultrasound by looking at a cross-section plane of the chest between the fetal lungs and the great vessels, where the thighbox is situated. Fluorescence in situ hybridization, multiplex ligation, dependent probe amplification, and chromosomal microarray analysis can confirm the most common 1.5 to 3 MP deletions in fetuses with features of 22 Q11 through amniocentesis or corionic bill assembly. Recently, non-invasive prenatal screening for micro deletion syndromes from cell-free fetal DNA in maternal plasma is advised. Conclusion, while the majority of the consensual heart diseases are initially detected on routine metriomestronomy scan, followed with fetal echocardiogram in consultation with a maternal fetal medicine specialist or a pediatric cardiologist remains critical, best classified, diagnosing and creating a postnatal treatment plan to maximize the outcome. These are my references.