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Prenatal diagnosis of gall bladder anomalies--report of 17 cases
M Bronshtein1, Z Weiner, H Abramovici
1Al-Kol Institute of Sonography, Haifa, Israel.
Insights
Fetal gall bladder anomalies, including agenesis and malformations, were detected in 17 cases out of 10,016 examinations. Early detection by 15 weeks
Area of Science:
- Medical Imaging
- Fetal Medicine
- Gastroenterology
Background:
- Fetal gall bladder anomalies are rare but can be detected during routine prenatal ultrasound examinations.
- Understanding the spectrum and implications of these anomalies is crucial for accurate diagnosis and management.
- Previous literature on fetal gall bladder anomalies is limited, necessitating further investigation.
Purpose of the Study:
- To report the incidence and types of fetal gall bladder anomalies detected during systemic fetal examinations.
- To investigate the association of these anomalies with other fetal malformations and chromosomal abnormalities.
- To explore the diagnostic criteria and potential prognostic implications of fetal gall bladder anomalies.
Main Methods:
- A retrospective analysis of 10,016 fetal systemic examinations performed over six years.
- Identification and characterization of fetal gall bladder anomalies using sonographic imaging.
- Correlation of gall bladder anomalies with post-abortal and post-partum findings, other fetal malformations, and chromosomal analysis (e.g., Trisomy 18).
Main Results:
- Seventeen cases of fetal gall bladder anomalies were identified (0.15% incidence).
- Seven cases of gall bladder agenesis, six of left-sided gall bladder, one of 'floating' gall bladder, and two of septated/bilobed gall bladder were observed.
- Associated fetal malformations were noted in five cases (two agenesis, three left-sided), and dysmorphic gall bladders with intrauterine growth retardation were seen in two cases, one with Trisomy 18.
Conclusions:
- Failure to visualize the fetal gall bladder by 15 weeks' gestation is indicative of its absence.
- This finding necessitates a differential diagnosis between gall bladder atresia (good prognosis) and external biliary atresia (poor prognosis).
- Further research is required to fully characterize fetal gall bladder malformations and their associated prognoses.
Abstract:
We describe here 17 cases of fetal gall bladder anomalies, detected as early as the 14th week of gestation, out of 10,016 fetal systemic examinations performed by us in the last 6 years (0.15 per cent). In seven cases, agenesis of the fetal gall bladder was detected. The diagnosis was confirmed by post-abortal examination in five cases and in two post-partum. In six other cases, a left-sided gall bladder and in one case, a 'floating' gall bladder were detected at 15 weeks' gestation. In two cases, a septated or bilobed gall bladder was visualized. None of these 15 cases was dyskaryotic, but in five cases, two with agenesis and three left-sided gall bladders were associated with other fetal malformations. In two other cases, the gall bladder appeared dysmorphic on sonographic examination and in both of them intrauterine growth retardation and other anomalies were detected. Trisomy 18 was diagnosed by amniocentesis in one of them. According to our experience, failure to visualize the fetal gall bladder by the 15th gestational week is diagnostic of its absence and should raise the differential diagnosis between gall bladder atresia, which has a good prognosis, and external biliary atresia, which has a poor prognosis. Further experience is needed to characterize the various gall bladder malformations and their prognosis.