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.
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Epiemiology
The estimated incidence is ~6-10 per 10,000 pregnancies.
Pathology
Etiology
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 ischemic event (arterial)
However, many cases are idiopathic.
Associations
There may be an increased risk of chromosomal anomalies (especially when additional anomalies are present 2).
Radiographic feautures
Ultrasound
Typically seen as one or many 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.
Differential diagnosis
General differential considerations include
perihepatic calcification, e.g. from meconium peritonitis
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