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Evaluation of the patient at risk for fetal infection is challenging. Serologic studies may be inconclusive and often do not provide meaningful information about prognosis. Recent technologic advances have expanded the role of prenatal ultrasound in both anomaly detection and guidance for invasive diagnostic procedures. For the patient with a known or suspected fetal infection, sonographic identification of characteristic abnormalities can provide useful information for counseling and perinatal management. Demonstration of such findings in the low-risk patient may serve to identify the fetus with a previously unsuspected infection.This article reviews the sonographic manifestations of fetal infection and the role of ultrasound in the evaluation of the fetus at risk for congenital toxoplasmosis, rubella, cytomegalovirus (CMV), and the herpesviruses (TORCH infections), and syphilis.