Citation, DOI & article data
Fetal hepatomegaly (or more simply an enlarged fetal liver) can occur in number of situations. It can occur with or without fetal splenomegaly.
- in utero infections: the commonest cause
- hydrops fetalis 4
- fetal anemia: due to hydrops-related liver congestion or extramedullary hematopoiesis
- liver storage diseases
- transient abnormal myelopoiesis (TAM): is a preleukemic syndrome that is almost exclusively associated with trisomy 21. It tends to give hypoechoic hepatomegaly 1,2
- due an underlying syndromic association
- fetal hypothyroidism
- biliary atresia
- hepatic tumors: rare
It is often overlooked, yet the liver is the largest abdominal organ and fetal hepatomegaly can be detected with careful detection of associated findings and specific hepatic and nonhepatic imaging characteristics.
Fetal liver length can be measured from the diaphragm to the tip of the right lobe in coronal or sagittal plane, with comparison to reference charts 6.
Signs of fetal hepatomegaly:
- primary signs
- right lobe extending caudally beyond the inferior pole of the right kidney
- convex appearance of the hepatic contour
- displacement of the gastric fundus by enlarged left lobe.
- secondary signs
As the liver shares in fetal erythropoiesis, fetal hepatomegaly increases fetal hemoglobin level that increases liver iron content as well as protein, copper, and zinc 5.
- T1: high signal
- T2: low signal
MRI is the best for diagnosis of fetal hepatic tumors and other diseases with specific MRI features such as biliary atresia.
Treatment and prognosis
It is associated with high fetal morbidity and mortality. Some of the associated diseases and etiologies are treatable in the fetal period.
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- 2. Hamada H, Yamada N, Watanabe H et-al. Hypoechoic hepatomegaly associated with transient abnormal myelopoiesis provides clues to trisomy 21 in the third-trimester fetus. Ultrasound Obstet Gynecol. 2001;17 (5): 442-4. doi:10.1046/j.1469-0705.2001.00362.x - Pubmed citation
- 3. Ceola AF, Angtuaco TL. US case of the day. Congenital cytomegalovirus infection. Radiographics. 19 (5): 1385-7. Radiographics (full text) - Pubmed citation
- 4. Nyberg DA, McGahan JP, Pretorius DH. Diagnostic imaging of fetal anomalies. Lippincott Williams & Wilkins. (2003) ISBN:0781732115. Read it at Google Books - Find it at Amazon
- 5. Kyle K. Jensen, Karen Y. Oh, Neel Patel, et-al. Fetal Hepatomegaly: Causes and Associations. (2020) RadioGraphics. 40 (2): 589-604. doi:10.1148/rg.2020190114 - Pubmed
- 6. Paula J. Woodward, Anne Kennedy, Roya Sohaey. Diagnostic Imaging: Obstetrics. (2016) ISBN: 9780323392563
- 7. Surmeli-Onay O, Yakarisik S, Korkmaz A, et-al. Prenatal-onset Niemann-Pick type C disease with nonimmune hydrops fetalis. (2013) Pediatrics and neonatology. 54 (5): 344-7. doi:10.1016/j.pedneo.2013.01.015 - Pubmed