To distinguish a periventricular blush from periventricular leukomalacia, the brain should be viewed from which fontanelle?

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The window you choose for neonatal cranial ultrasound changes what parts of the brain you can see clearly. Viewing from the posterior fontanelle gives a direct, sagittal-like view of the posterior periventricular white matter and the occipital horn of the lateral ventricles. PVL characteristically affects the periventricular white matter and is often more conspicuous in the posterior periventricular region, so this window makes it easier to see true loss of normal periventricular architecture or early cystic change. A periventricular blush, by contrast, tends to be a milder, more symmetric echogenicity that doesn’t disrupt the periventricular tissue pattern, and it is easier to distinguish when you can assess the posterior periventricular area from this window. Using the posterior fontanelle also helps track evolution over time and assess symmetry, aiding differentiation between benign blush and real PVL.