{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T14:58:29Z","timestamp":1780498709373,"version":"3.54.1"},"reference-count":13,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2012,3,22]],"date-time":"2012-03-22T00:00:00Z","timestamp":1332374400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2012,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\u2018Starry sky\u2019 liver is one of the most common sonographic patterns in diffuse liver disease. It is characterized by clearly identified portal venules due to diminished parenchymal echogenicity. In advanced cases of twin\u2010to\u2010twin transfusion syndrome (TTTS), volume overload is considered the key factor in the pathogenesis of cardiac dysfunction of the recipient twin. When right\u2010sided failure occurs, the liver might show signs of edema and, as in acute hepatitis, the appearance of starry sky might develop. We present a case in which the sonographic appearance of starry sky liver, along with right\u2010sided cardiac failure (tricuspid regurgitation), were the first signs of TTTS in monochorionic twins at 20 weeks. A short time later, at 21 weeks, other signs of overload and signs of worsening heart failure were noted, as the typical triphasic waves in the inferior vena cava were replaced by a biphasic flow profile. Twin 2 at that time had relative oligohydramnios. A few days later, relative polyhydramnios and edema of the placental domain of the recipient twin were also noted. To the best of our knowledge, this is the first case report describing this hepatic sonographic pattern as an early sonographic sign of TTTS. Copyright \u00a9 2012 ISUOG. Published by John Wiley &amp; Sons, Ltd.<\/jats:p>","DOI":"10.1002\/uog.10063","type":"journal-article","created":{"date-parts":[[2011,8,11]],"date-time":"2011-08-11T14:10:34Z","timestamp":1313071834000},"page":"723-725","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Starry sky pattern of fetal liver sonogram as first sign of twin\u2013twin transfusion syndrome"],"prefix":"10.1002","volume":"39","author":[{"given":"Y.","family":"Segev","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y.","family":"Goldberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Riskin\u2010Mashiah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Berdicef","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O.","family":"Lavie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Auslender","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2012,3,22]]},"reference":[{"key":"e_1_2_3_2_2","first-page":"153","article-title":"Twin\u2010twin transfusion syndrome","volume":"61","author":"Rossi AC","year":"2009","journal-title":"Minerva Ginecol"},{"key":"e_1_2_3_3_2","first-page":"163","article-title":"Flow changes in hepatic veins in congestive cardiac insufficiency: a study using pulsed Doppler US","volume":"9","author":"Alvarez G","year":"1989","journal-title":"Eur J Radiol"},{"key":"e_1_2_3_4_2","first-page":"57","article-title":"Diffuse benign liver disease","volume":"23","author":"Needleman L","year":"1988","journal-title":"Clin Diagn Ultrasound"},{"key":"e_1_2_3_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/15.9.2008"},{"key":"e_1_2_3_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/uog.7533"},{"key":"e_1_2_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.clp.2009.03.003"},{"key":"e_1_2_3_8_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.136.3.7403553"},{"key":"e_1_2_3_9_2","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.178.1.1780078"},{"key":"e_1_2_3_10_2","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.137.3.606"},{"key":"e_1_2_3_11_2","doi-asserted-by":"publisher","DOI":"10.7863\/jum.1988.7.5.279"},{"key":"e_1_2_3_12_2","doi-asserted-by":"publisher","DOI":"10.7863\/jum.1996.15.5.405"},{"key":"e_1_2_3_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e3181c99304"},{"key":"e_1_2_3_14_2","doi-asserted-by":"publisher","DOI":"10.3109\/08860221003728713"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fuog.10063","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.10063","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T16:38:37Z","timestamp":1700584717000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.10063"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2012,3,22]]},"references-count":13,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2012,6]]}},"alternative-id":["10.1002\/uog.10063"],"URL":"https:\/\/doi.org\/10.1002\/uog.10063","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,3,22]]},"assertion":[{"value":"2011-07-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2012-03-22","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}