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Radiology
Fetal Hepatic Calcification
Built from Obstetric Imaging
What’s inside
8 sections · 74 slides
Overview
- Why this finding matters
- What this deck covers
What the finding is
Defining the bright spot, and the three places calcium can sit
- What we mean by a liver calcification
- Why the word calcification is loose here
- Three places calcium can sit in the fetal liver
- The three types at a glance
How often it is seen
Autopsy series, routine scanning and referral centres give very different numbers
- Two very different sets of numbers
- What routine scanning actually finds
- Why one centre reported four times more
- A larger recent series
- What seven prenatal series add up to
- Summary of Studies of Prenatally Detected Intrahepatic Calcifications Published Since 1990 - cases and timing
- Summary of Studies of Prenatally Detected Intrahepatic Calcifications Published Since 1990 - findings and outcome
- The seven prenatal series side by side
- How to read that table
Why the calcifications form
Chromosomes, blood-vessel accidents, infection and, rarely, tumours
- The classic three explanations
- The link with chromosome problems
- Calcification doubles the odds
- How a blood-vessel accident leaves calcium
- Three proposed vascular routes
- What triggers those vascular events
- Why the spot may vanish before birth
- A very different picture in miscarriages
- Cases of Spontaneous Miscarriages
- What that miscarriage table tells you
- Autopsy work points the same way
- Infection: cytomegalovirus leads the list
- Cells enlarged by cytomegalovirus
- An infected fetus rarely shows just one sign
- How an infection may end in calcium
- How sure are we about that chain?
- Tumours look different
How it shows up on the scan
Who gets scanned, when the specks appear, and what the images look like
- How the finding is usually discovered
- Maternal history that prompts a closer look
- When the specks become visible
- What ultrasound actually shows
- Scattered specks in a 22-week fetal liver
- Cross-section of the same abdomen at 22 weeks
- Side-on view at 28 weeks
- Shadowing behind the brighter specks
- Following that case through to delivery
- Liver specks after a co-twin died
- How that twin ended up
- The pattern gives a clue
- Where MRI fits
- “
What else it could be
Look-alikes inside the liver, on its surface, and in the organs next door
- Specks inside the liver: three buckets
- Gallstones can mimic the finding
- Specks on the surface mean something else
- Check the neighbouring organs
- Where else to look in the fetal abdomen
- A rare but serious mimic
- What that mimic looks like before birth
What to do about it
No treatment for the speck itself - the work is finding out why, then watching
- There is no prenatal treatment
- The prenatal work-up in four steps
- Step one: look everywhere else
- Step two: amniocentesis
- Drawing fluid from the sac around the fetus
- Step three: maternal blood tests
- Step four: repeat the scan
- Where to deliver
- After birth: examine the baby
- After birth: which tests
- Reassuring versus worrying
- What the referring physician needs to know
- What to tell the family
- 0.06–0.38%
- Key points
- Key points, continued
Sources
The reference list behind every number on these slides
- Suggested readings
- References
- References (continued)
- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition