Nonvisualization of the Fetal Gallbladder in Early Pregnancy: Comparison with Clinical Outcome

Abstract

Nonvisualization of the fetal gallbladder in early pregnancy is uncommon but associated in many cases with other fetal anomalies.

Nonvisualization of the fetal gallbladder by second‐trimester ultrasound scan: strategy of clinical management based on four examples

“…In three prospective studies, isolated agenesis of the gallbladder explained 12 to 28% of nonvisualization of the gallbladder (Bronshtein et al, 1993;Blazer et al, 2002;Ochshorn et al, 2007). In the present study, amniotic fluid digestive enzymes assays were performed in two of the four cases (amniocentesis not performed in one case and enzymes were not assayed in the other).…”

“…Nonvisualization of the fetal gallbladder is rare and occurs in 0.1% to 0.15% of pregnancies (Bronshtein et al, 1993;Blazer et al, 2002), Hertzberg et al (1996) reported a frequency of 7.1%, which may be explained by the small number of patients included between 20 and 24 weeks of gestation (n = 84).…”

“…When nonvisualization of the gallbladder is confirmed by a second US examination performed 7 to 15 days later, the etiology should be investigated because of the association with various abnormalities, such as renal agenesis, hydronephrosis, cerebral ventricular dilatation, chromosomal anomalies (particularly trisomy 21), cystic fibrosis, biliary atresia, and multiple malformation (Bennion et al, 1988;Bronshtein et al, 1993;Duchatel et al, 1993;Albayram et al, 2002;Ben-Ami et al, 2002;Simon-Bouy et al, 2002;Blazer et al, 2002;Ochshorn et al, 2007). However, the absence of indications in the US does not exclude severe abnormalities, such as cystic fibrosis or biliary duct atresia.…”

“…However, the absence of indications in the US does not exclude severe abnormalities, such as cystic fibrosis or biliary duct atresia. In cystic fibrosis, nonvisualization of the gallbladder may be isolated or associated with bowel dilatation, or hyperechogenic fetal bowel, ascites, or meconium peritonitis (Duchatel et al, 1993;Blazer et al, 2002). Biliary atresia is either syndromic (10% of cases), and if so associated with anomalies (intestinal malrotation, situs inversus, malposition of the spleen, cardiac defect), or nonsyndromic (Chardot, 2006).…”

“…In such cases, a gallbladder undetected prenatally is sometimes visualized postnatally in a disease-free child (Hertzberg et al, 1996;Blazer et al, 2002).…”