Abstract: Objective To investigate the features of ultrasound imaging of fetal total anomalous pulmonary venous drainage (TAPVD). Methods A total of 58 cases diagnosed as TAPVD in our hospital from June 2009 to December 2019 were analyzed.Prenatal diagnosis was confirmed by postpartum autopsy,postpartum echocardiography or surgery.The prenatal ultrasound findings and ideas of prenatal diagnosis of TAPVD were summarized.The causes of missed diagnosis were analyzed. Results Among the 58 cases,there were 16 cases of supracardiac type,15 cases of infracardiac type,18 cases of intracardiac type and 9 cases of mixed type.We found that 39 cases (39/58,67.2%) had other malformations,and 19 cases (19/58,32.8%) were isolated TAPVD.All the cases of TAPVD complicated other malformations were correctly diagnosed by prenatal ultrasound,but diagnosis of isolated TAPVD was missed by prenatal ultrasound in 8 cases,with a missed diagnosis rate of 13.8% (8/58).The common ultrasonographic findings of TAPVD included absent insertions of pulmonary veins in the left atrium;increased distance between left atrium and descending aorta;common pulmonary vein trunk behind or on the side of left atrium,the drainage path could be detected by following the tracks of common pulmonary vein and vertical veins with vasodilation at the corresponding drainage site;pulmonary vein obstruction showing high velocity turbulence on color doppler flow imaging. Conclusion TAPVD has typical characteristics on images of prenatal ultrasound.Prenatal ultrasound can accurately classify TAPVD and assess whether it is associated with pulmonary venous obstruction and other malformations.Isolated TAPVD is easily missed diagnosed by prenatal ultrasound.