HEPATIC CALCIFICATION

ULTRASOUND

• May be localized or diffuse segmental.
• Hyperechogenicities may either represent fibrosis or precursor of calcification. Calcifications may disappear on subsequent scans possibly due to the regenerative capacity of the liver as well as normal liver growth (1).

Single liver calcification
Multiple liver calcifications

ETIOLOGY (2)

• Peritoneal hepatic calcifications on the liver surface.
• Meconium peritonitis.
• Plastic peritonitis due to hydrometrocolpos (3).
• Intraparenchymal hepatic calcifications.
• TORCH infections.
• Varicella infection (4).
• Hepatic tumors.
• Hemangioma.
• Hemangioendothelioma.
• Hamartoma.
• Teratoma.
• Hepatoblastoma.
• Metastatic neuroblastoma.
• Biliary tumerfactive sludge.
• Vascular calcifications.
• Portal and hepatic vein thromboemboli (5).
• Vascular insufficiency associated with ischemic infarcts.

Twin-Twin Transfusion Syndrome – post endoscopic ablation of placental anastomoses. Calcifications developing in donor liver due to previous vascular emboli from recipient twin. Note the course pattern and echogenic non shadowing areas in the liver of the donor twin.
Postnatal views of the liver

• Dystrophic.
• Idiopathic (6).
• Calcification in the tip of the left lobe of the liver. Commonly seen as a bright echo in the left upper quadrant of the fetus. It is isolated and seen in about 1:50 pregnancies. It has no significance, but must not be mistaken for meconium peritonitis.

Air in the hepatic vessels after fetal death may produce an appearance of echogenicities in the liver (7).

REFERENCES

1. Bronshtein M, Blazer S. Prenatal diagnosis of liver calcifications. Obstetrics and Gynecology 1995;86(5):739-743.
2. Avni EF, Rypens F, Donner C et.al. Hepatic cysts and hyperechogenicities: perinatal assessment and unifying theory on their origin. Pediatr Radiol 1994;24:569-572.
3. Ceballos R, Hicks GM. Plastic peritonitis due to neonatal hydrometrocolpos: radiologic and pathologic observations. J Pediatr Surg 1970;5:63-70.
4. Pretorius DH, Hayward I, Jones KL et.al. Sonographic evaluation of pregnancies with maternal varicella infection. J Ultrasound Med 1992;11:459-463.
5. Blanc WA, Berdon WE, Baker DH et.al. Calcified portal vein thromboemboli in newborn and stillborn infants. Radiology 1967;88:287-292.
6. Shackelford GD, Kirks DR. Neonatal hepatic calcification secondary to transplacental infection. Radiology 1977;122:753-757.
7. Weinstein BJ, Platt LD. The ultrasound appearance of intravascular gas in fetal death. J Ultrasound Med 1983;2:451-454.