This group of congenital heart disease (CHD) includes anomalies of the systemic and pulmonary venous vessels. Systemic venous anomalies result from abnormalities in the development of the following embryonic systems: umbilical, vitelline, and cardinal. Anomalous pulmonary venous return results from atresia of the common pulmonary vein or failure of its connection to the left atrium. It is of utmost importance to visualize at least one or more of the four pulmonary veins draining into the left atrium on routine fetal ultrasound to rule out this diagnosis. It is important to emphasize that total anomalous pulmonary venous drainage, especially the obstructive form, is objectively a critical CHD. Otherwise, systemic venous anomalies have the potential to cause fetal heart failure and affect liver function. In such cases, prenatal diagnosis is of paramount importance. Advances in ultrasound technology have shown that variants of venous anatomy, once considered unusual, are more common than previously thought. Three- and four-dimensional (3D/4D) ultrasound, high-resolution color Doppler, and power Doppler are valuable tools for evaluating the venous system, improving our understanding of its intricate anatomy, and helping to provide patients with convincing and accurate advice regarding their therapeutic management. In this chapter, we describe the key points for sonographic diagnosis of many of the most common systemic and pulmonary venous anomalies.