Echogenic material in the fetal gallbladder and fetal disease

Abstract

The presence of echogenic material within the gallbladder is probably a rare finding in the fetus, and the list of predisposing factors known for postnatal life seems not to be applicable to prenatal diagnosis. In the present study 1656 obstetric scans were performed on referrals to the Unit of Fetal Medicine. No echogenic gallbladder contents were found before 28 weeks. In the subgroup of 523 fetuses who were examined during gestational weeks 28-42, six fetuses were found to have echogenic material in the gallbladder. The echogenicities were found in patients who had the following: extra-amniotic hematoma with intrauterine growth retardation and oligohydramnios, tetralogy of Fallot, trisomy 21 with atrioventricular septal defect and transient ascites, early abnormally distended fetal gallbladder, chromosomal aberration (translocation 10; 11) with bilateral clubfoot, and gastroschisis. Echogenic densities had disappeared at ultrasound scans performed during early postnatal life in four cases, were absent at five weeks in one case, and still present as calculi 8 months after birth in one case. Although no causative conclusions can be drawn from the report, these conditions are suggested as possible predisposing factors for the presence of echogenic material in the fetal gallbladder.

Fetal gallstones detected by routine third trimester ultrasound

“…Interestingly, although Suma et al reported two cases of fetal gallstones among male neonates, they suggested no gender predominance [2]. Nevertheless, most series, including the present report, found an association with male gender [1,3]. No clear explanation could be suggested regarding this association.…”

“…Kiserud et al [1] established a list of predisposing factors associated with fetal echogenic gallbladder, including congenital malformations such as tetralogy of Fallot, bilateral clubfoot, and gastroschisis, chromosomal abnormalities (trisomy 21, translocation 10; 11) and extra-amniotic hematoma with intrauterine growth restriction. Other studies, on the contrary, found fetal gallstones as a benign, isolated condition [2,3].…”

What is Your Diagnosis?

“…Kiserud et al reported a list of predisposing factor associated with echogenic fetal gallbladder including chromosomal aberrations, cardiac malformations, gastroshisis and intrauterine growth restriction, influence of prostaglandin and possibly prenatal leukomoid reaction (2). However, in our case, and in those described by others, no common etiological factor was found (2,3,5). The only common factor, in a case in the literature was reported as echogenic foci in the gall bladder as a third trimester phenomenon (3,5,6).…”

“…Although we reported a female fetus with no predisposing factor, greater numbers of cases reported in the literature were male (1-3). However, no clear explanation could be suggested regarding this association (2). We suggested that due to the scarcity of cases found and the fact that underlying etiologicl reasons could not be found, the fetal gender may not be associated with gallstones.…”

“…Although recent advances in fetal ultrasonography have allowed these cases to be diagnosed prenatally, little is known about the natural history and clinical significance of fetal gallstones (1)(2)(3). Fetal gallstones are rare conditions and the prevalence of fetal gallstones is unknown.…”