The variable appearances of fetal gallstones

Abstract

Only four cases of fetal gallstones have been reported previously, which implies that this condition is rare. Gallstones in children have been reported more frequently, and it may be that some of these are present in fetal life. Over a 12 month period in this department, seven cases of gallstones or sludge were seen within the fetal gallbladder. The variable appearances of fetal cholelithiasis are described and the possible causes discussed. Fetal gallstones may not be as rare as indicated by the paucity of cases in the literature.

Fetal Gallstones

“…The increase in maternal oestrogen levels is a predisposing factor according to Brown and Teele [3]. The use of narcotics is another hypothesis to explain gallstone formation in fetal life [4]. The presence of a placental haematoma with a subsequent breakdown of haemoglobin to bilirubin is another explanation for the formation of gallstones.…”

Magnetic resonance imaging of the fetal gallbladder and bile

“…In prenatal imaging, assessment of the gallbladder is important as its non-visualisation may indicate abnormalities ranging from gallbladder agenesis without serious clinical sequelae to biliary atresia, which carries a poor prognosis [4,5]. The MRI characteristics of fetal gallbladder bile are of particular interest in the light of reports on fetal gallstones and gallbladder sludge in the prenatal ultrasound literature [6][7][8].…”

Fetal gallstones in a contracted gallbladder: potential to simulate hepatic or peritoneal calcification.

“…Some of the sonographic patterns found for fetal cholelithiasis are similar to those found after birth, such as foci with posterior shadowing, posterior "comet tail" artifacts, foci without posterior shadowing or artifact, and layering material resembling the appearance of sludge in the adult gallbladder. [2][3][4]9 In most previously diagnosed cases, the identity of the foci as originating from the gallbladder was apparent readily at antenatal sonography, because the foci clearly were contained within a fluid-filled structure corresponding in location and configuration to the gallbladder. Indeed, in three fetuses the gallbladders were enlarged, and it was the large gallbladder rather than the stones that was initially recognized.…”

“…Many gallstones resolve spontaneously in utero or soon after birth, and those that persist are rarely symptomatic. [1][2][3][4][5][6][7][8] Familiarity with the range of appearances of gallstones is important to avoid confusing them with potentially more serious pathologic conditions. Some of the sonographic patterns found for fetal cholelithiasis are similar to those found after birth, such as foci with posterior shadowing, posterior "comet tail" artifacts, foci without posterior shadowing or artifact, and layering material resembling the appearance of sludge in the adult gallbladder.…”

“…[1][2][3][4][5][6][7] The identity of the stones usually is readily apparent, because these echogenic foci often are found within a gallbladder recognizable by a characteristic location and configuration. If the gallbladder is contracted, however, the echogenic foci may not be perceived as gallstones and therefore could be misdiagnosed as other, more ominous entities, such as liver or peritoneal calcifications.…”