Fetal “gallstones” are still an unsolved mystery. Case series.

Dan Boitor Borza, Cristina Ioana Rotar, Mihaela Oancea, Daniel Muresan

Abstract


Background. Echogenic content in the fetal gallbladder is rather an incidental finding during third-trimester ultrasonography. The etiology, clinical course, and prognosis of this condition are still unclear. We highlight the demographic, clinical and ultrasound characteristics of our patients with echogenic content in the fetal gallbladder.

Methods. This is a retrospective single-center study conducted at the University of Medicine and Pharmacy Cluj-Napoca, Romania, between March 2022 and April 2023. All pregnant patients who were admitted to the hospital and had echogenic content in the fetal gallbladder detected by ultrasound were identified. The clinical and ultrasonography parameters were obtained from the databases of the ultrasound units and the medical records of the patients.

Results. Four patients were found to have echogenic content in the fetal gallbladder. The mean maternal age at diagnosis was 27.5 years (range 25–31). All patients had singleton pregnancies. The mean gestational age at diagnosis was 36.5 weeks (range 35–40). In all cases, the predominant aspect of echogenic content on ultrasound was multiple hyperechogenic foci; additionally, in one case, sludge was also observed. The mean maximal length of the hyperechogenic foci was 3.375 mm (range 1.6–5.4). All fetuses were delivered at full term, either vaginally or by cesarean section. The mean weight at birth was 3082.5 g (range 2800–3450). In all four cases, the EC disappeared spontaneously at birth. Neither of the four newborns displayed digestive symptoms or complications during the follow-up.

Conclusion. The EC is still a medical mystery since little is known about its etiology and long-term outcome. Many cases are likely to be undetected until after birth; therefore, fetal gallbladder examination should be included in the US routine. The condition appears to be benign, and usually, it improves naturally after birth. Consecutively, asymptomatic newborns with EC can be managed through a wait-and-see approach.


Keywords


fetal gallstones; fetal cholelithiasis; fetal biliary echogenic content; fetal echogenicities; fetal gallbladder

References


Annac G, Tekin AB. Echogenicities in the fetal gallbladder: Prevalence, sonographic findings, and postnatal outcomes. J Clin Ultrasound. 2022 Jan;50(1):74-79.

Beretsky I, Lankin DH. Diagnosis of fetal cholelithiasis using real-time high-resolution imaging employing digital detection. J Ultrasound Med. 1983 Aug;2(8):381-3.

Brown DL, Teele RL, Doubilet PM, DiSalvo DN, Benson CB, Van Alstyne GA. Echogenic material in the fetal gallbladder: sonographic and clinical observations. Radiology. 1992 Jan;182(1):73-6.

Troyano-Luque J, Padilla-Pérez A, Martínez-Wallin I, et al. Short- and long-term outcomes associated with fetal cholelithiasis: a report of two cases with antenatal diagnosis and postnatal follow-up. Case Rep Obstet Gynecol. 2014;2014:714271.

Boitor-Borza D, Rotar IC, Staicu A, Constantin R, Muresan D. Echogenic Content in the Fetal Gallbladder: Systematic Review of Ultrasound Features and Clinical Outcome. Diagnostics (Basel). 2023 Jan 8;13(2):230.

Agnifili A, Verzaro R, Carducci G, et al. Fetal cholelithiasis: a prospective study of incidence, predisposing factors, and ultrasonographic and clinical features. Clin Pediatr (Phila). 1999 Jun;38(6):371-3.

Devonald KJ, Ellwood DA, Colditz PB. The variable appearances of fetal gallstones. J Ultrasound Med. 1992 Nov;11(11):579-85.

Holloway S, Edwards H. Antenatal diagnosis of fetal cholelithiasis. Ultrasound. 2010;18(3):152-154.

Kiserud T, Gjelland K, Bognø H, Waardal M, Reigstad H, Rosendahl K. Echogenic material in the fetal gallbladder and fetal disease. Ultrasound Obstet Gynecol. 1997 Aug;10(2):103-6.

Sepulveda W, Stagiannis KD. Echogenic material in the fetal gallbladder in a surviving monochorionic twin. Pediatr Radiol. 1996;26(2):129-30.

Sepulveda W, Wong AE. Echogenic material in the fetal gallbladder: prevalence, sonographic spectrum, and perinatal outcome in an unselected third-trimester population. J Matern Fetal Neonatal Med. 2020 Apr;33(7):1162-1170.

Schwab ME, Braun HJ, Feldstein VA, Nijagal A. The natural history of fetal gallstones: a case series and updated literature review. J Matern Fetal Neonatal Med. 2022 Dec;35(24):4755-4762.

Kesrouani A, Nassif N, Nasr B, Choueiry E, Chalouhi G. Ultrasound characteristics and outcome of prenatally diagnosed fetal cholelithiasis. J Matern Fetal Neonatal Med. 2019 Jun;32(12):2095-2099.

Hurni Y, Vigo F, von Wattenwyl BL, Ochsenbein N, Canonica C. Fetal Cholelithiasis: Antenatal Diagnosis and Neonatal Follow-Up in a Case of Twin Pregnancy - A Case Report and Review of the Literature. Ultrasound Int Open. 2017 Feb;3(1):E8-E12.

Iroh Tam PY, Angelides A. Perinatal detection of gallstones in siblings. Am J Perinatol. 2010 Nov;27(10):771-4.

Cancho Candela R, Díaz González J, Perandones Fernández C, Viñuela Rueda B, Relea Sarabia A, Andrés de Llano JM. Material ecogénico en vesícula biliar fetal: diagnóstico prenatal y seguimiento posnatal [Echogenic material in fetal gallbladder: prenatal diagnosis and postnatal follow-up]. An Pediatr (Barc). 2004 Oct;61(4):326-9.

Kahlon GK, Zylak A, Leblanc P, Kondamudi N. Fetal Gallstones in a Newborn after Maternal COVID-19 Infection. Case Rep Pediatr. 2021 Nov 18;2021:3688173.

Sileo FG, Tramontano AL, Leone C, et al. Pregnant woman infected by Coronavirus disease (COVID-19) and calcifications of the fetal bowel and gallbladder. Minerva Obstet Gynecol. 2021 Feb;73(1):121-124.

Triunfo S, Rosati P, Ferrara P, Gatto A, Scambia G. Fetal cholelithiasis: a diagnostic update and a literature review. Clin Med Insights Case Rep. 2013 Oct 15;6:153-8.

Suhag P, Mathur S, Bhardwaj PD. Fetal cholelithiasis: A Benign Rarity. PJSR.2014:7(2):63-66.

Stringer MD, Lim P, Cave M, Martinez D, Lilford RJ. Fetal gallstones. J Pediatr Surg. 1996 Nov;31(11):1589-91.

Suma V, Marini A, Bucci N, Toffolutti T, Talenti E. Fetal gallstones: sonographic and clinical observations. Ultrasound Obstet Gynecol. 1998 Dec;12(6):439-41.

Tonni G, Ruano R. Fetal cholelithiasis: What we know to counsel parents? J Clin Ultrasound. 2022 Jan;50(1):80-81.

Hertzberg BS, Kliewer MA. Fetal gallstones in a contracted gallbladder: potential to simulate hepatic or peritoneal calcification. J Ultrasound Med. 1998;17:667-670.

Gomez NA, Gutierrez JO. Comments of manuscript: ultrasound characteristics and outcome of prenatally diagnosed fetal cholelithiasis. J Matern Fetal Neonatal Med. 2020 Jul;33(13):2308.




DOI: http://dx.doi.org/10.11152/mu-4214

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