Fetal intrahepatic calcification can be a relatively common finding. Calcifications in the liver can be single or multiple and in most cases in which isolated hepatic calcific deposits are detected, there is usually no underlying abnormality.
The presence of isolated intrahepatic calcification is often of little clinical significance, especially if infection or associated chromosomal anomalies are excluded.
The estimated incidence is ~6-10 per 10,000 pregnancies.
Intrahepatic calcification in utero can result from a number of causes which include:
- in utero infection (especially the S-TORCH group*)
- vascular pathologies
- portal venous emboli
- hepatic ischaemic event (arterial)
However, many cases are idiopathic.
There may be an increased risk of chromosomal anomalies (especially when additional anomalies are present 2).
Typically seen as one or may echogenic foci within the liver. These may be rounded, flat or elliptical in shape. Dorsal echoes are usually absent.
Depending on other associated pathology, additional sonographic findings may be present which may include:
- presence of fetal ascites
Treatment and prognosis
The site, size, and distribution of the lesions are major factors in determining further management. Isolated intrahepatic calcification is associated with excellent post natal outcome. Some advocate fetal karyotyping when additional structural anomalies are present 8.
General differential considerations include
- perihepatic calcification, e.g. from meconium peritonitis
- 1. Stein B, Bromley B, Michlewitz H et-al. Fetal liver calcifications: sonographic appearance and postnatal outcome. Radiology. 1995;197 (2): 489-92. Radiology (abstract) - Pubmed citation
- 2. Simchen MJ, Toi A, Bona M et-al. Fetal hepatic calcifications: prenatal diagnosis and outcome. Am. J. Obstet. Gynecol. 2002;187 (6): 1617-22. Am. J. Obstet. Gynecol. (link) - Pubmed citation
- 3. Mcnamara A, Levine D. Intraabdominal fetal echogenic masses: a practical guide to diagnosis and management. Radiographics. 25 (3): 633-45. doi:10.1148/rg.253045124 - Pubmed citation
- 4. Bronshtein M, Blazer S. Prenatal diagnosis of liver calcifications. Obstet Gynecol. 1995;86 (5): 739-43. doi:10.1016/0029-7844(95)00278-Y - Pubmed citation
- 5. Achiron R, Seidman DS, Afek A et-al. Prenatal ultrasonographic diagnosis of fetal hepatic hyperechogenicities: clinical significance and implications for management. Ultrasound Obstet Gynecol. 1996;7 (4): 251-5. doi:10.1046/j.1469-0705.1996.07040251.x - Pubmed citation
- 6. Yamashita Y, Iwanaga R, Goto A et-al. Congenital cytomegalovirus infection associated with fetal ascites and intrahepatic calcifications. Acta Paediatr Scand. 1989;78 (6): 965-7. - Pubmed citation
- 7. Koopman E, Wladimiroff JW. Fetal intrahepatic hyperechogenic foci: prenatal ultrasound diagnosis and outcome. Prenat. Diagn. 1998;18 (4): 339-42. Prenat. Diagn. (link) - Pubmed citation
- 8. Merz E, Bahlmann F. Ultrasound in obstetrics and gynecology. Thieme Medical Publishers. (2005) ISBN:1588901475. Read it at Google Books - Find it at Amazon
- 9. Entezami M, Albig M, Knoll U et-al. Ultrasound Diagnosis of Fetal Anomalies. Thieme. (2003) ISBN:1588902129. Read it at Google Books - Find it at Amazon