Fetal hepatomegaly

Last revised by Dr Mostafa El-Feky on 12 Feb 2022

Fetal hepatomegaly (or more simply an enlarged fetal liver) can occur in number of situations. It can occur with or without fetal splenomegaly.

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.

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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Cases and figures

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