fetal intra-hepatic calcification

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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.

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*)
- * in utero cytomegalovirus infection
- * in utero rubella infection
- * in utero toxoplasmosis infection
- * in utero herpes simplex infection
- * in utero syphilis infection
- in utero parvovirus B19 infection
- in utero varicella zoster infection
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 ).

Radiographic feautures

Antenatal ultrasound

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 .

Differential diagnosis

General differential considerations include

perihepatic calcification, e.g. from meconium peritonitis