Fetal Cholelithiasis: Antenatal Diagnosis and Neonatal Follow-Up in a Case of Twin Pregnancy - A Case Report and Review of the Literature

Echogenic Content in the Fetal Gallbladder: Systematic Review of Ultrasound Features and Clinical Outcome

It is rare to detect echogenic content in the fetal gallbladder. The etiology, natural course, and prognosis of this condition remain unclear. In addition to providing a systematic review of this topic, we suggest a plan for patient follow-up. From a total of 100 database entries identified in PubMed, EMBASE, and ICTRP reviews, we selected 34 studies in which we investigated the ultrasound features and outcome of this condition. There were 226 fetuses with gallbladder echogenic content identified. Seventy-two fetuses were found to have biliary sludge; thirty cases had a single hyperechogenic focus, and one hundred fetuses had multiple foci in the gallbladder. There were 16 cases of distal shadowing, 37 fetuses with comet tail and twinkling, and 26 cases with no acoustic artifacts. Nine cases of spontaneous resolution before birth have been documented; nine fetuses exhibited no echogenic content at birth, and 138 cases of resolution of echogenic content within the first year of life have been described. Typically, the condition resolves spontaneously during the postnatal period. After adequately reassuring the parents, the patients should be monitored for spontaneous resolution; medical or surgical intervention is not indicated. Asymptomatic patients can be managed with a wait-and-see strategy.

The natural history of fetal gallstones: a case series and updated literature review

INTRODUCTION

The incidence of fetal gallstones is estimated at 0.45% and its clinical relevance after birth remains unknown. This study aimed to describe the natural history of fetal gallstones and their clinical sequelae after birth.

METHODS

We queried a database of fetuses referred for second and third trimester sonograms performed for high-risk pregnancies, and identified cases with fetal gallstones (1996-2019). Demographics, prenatal/postnatal imaging findings, and clinical sequelae were collected. A literature review was performed according to PRISMA guidelines.

RESULTS

We screened approximately 200,000 obstetric sonograms; 34 fetuses were found to have cholelithiasis. The median gestational age at the time of sonogram was 35 weeks (range 22-38). Fifty-six percent were female and 11.8% were twin pregnancies with one affected fetus. Median maternal age was 28 years (range 17-42). Eight fetuses underwent postnatal imaging and 4 had persistent cholelithiasis. There was one case of in utero demise. Two patients had structural anomalies (renal and cardiac) by sonogram. A subset of 17 patients was followed long-term (range 3-20 years), and none developed clinical sequelae from cholelithiasis.

DISCUSSION/CONCLUSIONS

No child developed postnatal clinical sequelae related to cholelithiasis identified in utero. Fetal cholelithiasis can be managed expectantly without follow-up imaging in asymptomatic patients.

Echogenicities in the fetal gallbladder: Prevalence, sonographic findings, and postnatal outcomes

PURPOSE

To investigate the prevalence of echogenicity in the fetal gallbladder (EFG) and to present prenatal sonographic findings and their postnatal outcomes.

MATERIALS AND METHODS

We performed a retrospective study within 17420 pregnant women during a 66-month period. Fetuses with an incidental finding of EFG in their 2nd or 3rd trimester of pregnancy were followed until birth per two weeks with sonographic examinations.

RESULTS

Out of 5977 fetuses, 44 fetuses were found to have EFG with a prevalence of 0.74%. Nine (20%) of 44 fetuses had single echogenicity, 25 (56%) had multiple echogenicities, 10 (22%) had sludge-like echogenicities. In Doppler sonography, 28 fetuses with EFG exhibited twinkling artifacts; however, none of the echogenicities had obvious acoustic shadowing. All of the cases were resolved either in utero or after birth before 10 months of age.

CONCLUSION

EFG is a late third-trimester phenomenon with a prevalence of 0.74%. Most EFGs presented as twinkling artifacts, suggesting they had a cholesterol component.

Fetal Gallstones in a Newborn after Maternal COVID-19 Infection

Fetal gallstones are rare incidental findings on ultrasound during pregnancy. We describe a newborn girl with gallstones that was born to a mother who had COVID-19 infection during her last trimester. The baby remained asymptomatic, and the stones resolved spontaneously without any treatment or complications within six weeks of birth. Several conditions predispose to fetal gallstones, and it is unclear if the recent maternal COVID-19 infection had any role in the occurrence of these abnormalities or was merely coincidental. This is the first case describing an association of fetal gallstones with a COVID-19 infection in pregnancy.

Echogenic material in the fetal gallbladder: prevalence, sonographic spectrum, and perinatal outcome in an unselected third-trimester population

Objective: To determine the prevalence, sonographic spectrum, and clinical significance of echogenic material in the fetal gallbladder in our population.Methods: Sonographic visualization of the fetal gallbladder was attempted in 3894 consecutive third-trimester pregnancies (4026 fetuses). Gallbladder content was classified as clear (anechoic), containing echogenic material that was either diffuse (sludge), or presenting as a single focus or multiple foci (gallstone(s)). Information on the clinical course was obtained by reviewing the medical records or contacting the provider or the parents themselves.Results: During the three and a half-year study period from July 2014 to December 2017, 19 fetuses were identified as having echogenic material in the gallbladder (prevalence 1/211, 0.47%). Among them, echogenic biliary sludge was found in eight fetuses (42%); all eight were asymptomatic and a normal gallbladder was documented postnatally in four of them. Single (n = 3) or multiple (n = 8) echogenic foci were found in 58% of cases, which was associated with a good prognosis and subsequent resolution between 1 and 10 months of life in all cases.Conclusions: The prevalence of echogenic material in the fetal gallbladder in our population was similar to that previously reported in the literature. The prognosis appears to be favorable, with resolution and without subsequent postnatal hepatic or gastrointestinal complications in all cases.

Ultrasound characteristics and outcome of prenatally diagnosed fetal cholelithiasis

AIM

To investigate ultrasound characteristics and outcome in fetuses with cholelithiasis.

MATERIALS AND METHODS

We report a small case series of three patients with prenatally diagnosed fetal cholelithiasis. Ultrasound features, pregnancy outcome and neonatal follow-up are presented and discussed.

RESULTS

Sonographic pattern associated to fetal cholelithiasis is variable. Pregnancy issue is globally good with no ominous fetal or neonatal events.

CONCLUSIONS

Prenatally diagnosed fetal cholelithiasis is a rare finding and doesn't seem to carry an adverse effect on the pregnancy.