Hepatic Fetal Calcifications: A Case Report

Introduction Fetal hepatic calcifications are hyperechoic areas similar to bone tissue that are usually found during the II trimester screening between 18 and 23 week of postmenstrual age (PMA). The reported incidence is 1:750 to 2,000 live fetuses, 33:1,500 in spontaneous miscarriages, and the localization depends on etiology. The pathophysiology of hepatic calcifications occurring in the second trimester of pregnancy is different from that of third trimester. In the second trimester, the acidotic conditions in particular at the subcapsular level promote the deposition of mainly superficial calcium salts while the typical coagulative pattern of the third trimester would favor the calcium deposit in periportal areas. According to the Carroll and Maxwell classification, lesions may be peritoneal (consequence of meconium peritonitis), parenchymal (linked to tumors and infections), and vascular (linked to thrombosis or hepatic ischemia). Ascites is a negative prognostic predictive sign. Isolated calcifications have a good outcome, whereas poor prognosis occurs when these lesions are multiple and associated to other malformations and cromosomopathies (e.g., trisomy 13 and 21)

Materials and Methods We describe a case of a male fetus with occasional finding at morphological ultrasound (US) scan (at 20^3/7 weeks of PMA) of calcifications surrounding the outer margin of the liver for a length of 1.72 cm. Toxoplasmosis, cytomegalovirus, parvovirus B19 serologies were negative, amniocentesis revealed a 46 XY karyotype. The mother was followed by ultrasound scan controls at 21^4/7 weeks of PMA that confirmed the hyperechogenic area apparently covering the whole hepatic surface and measuring 3.13 × 1.39 cm. On control at 23^5/7 weeks of PMA, intestinal microcalcifications were also detected. The fetus presented regular growth at 23^5/7 weeks. A cesarean sections (CS) was scheduled at 39 weeks of PMA (because of previous CS and patient’s refusal to try Vaginal birth after cesarean section). Once born, the newborn showed normal adaptation to extrauterine life, featuring a regular umbilical cord with three vessels, with venous pH and base excess at birth being normal. A laboratory workup was performed and the neonate showed normal hepatic profile. The first abdomen ultrasound was performed at 1 day of life and confirmed the presence of “rosary-crown” calcifications on the Glissonian surface, in the context of otherwise regular abdominal anatomical findings. The child was discharged on day 4 of life in good conditions. A second ultrasound was repeated at one month of life and confirmed the previous findings.

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Conflict of Interest

None declared.