EP07.09: Fetal gallstones or something more?

A 30-year-old parous woman was having serial growth scans for a small for gestational age fetus first detected at 28 weeks gestation. Prior to this she had low-chance trisomy screening and a normal routine anomaly scan at 19+6 weeks. An ultrasound scan at 34+5 (see figure 1a) demonstrated the presence of several discrete echogenic foci within the fetal gallbladder. A presumptive diagnosis of fetal gallstones (cholelithiasis) was made and a postnatal ultrasound arranged. Labour was induced at 37+0 weeks due to late-onset fetal growth restriction and resulted in the live birth of a healthy female infant weighing 2.62kg (6th centile). A postnatal ultrasound (see figure 1b) at 6 weeks of age identified 4-8 echogenic foci adherent to the gallbladder wall with comet tail and twinkling artefact. The gallbladder shape and size were otherwise unremarkable with no identifiable thickening in the unaffected areas. An ultrasound (see figure 1c) at 4 months revealed a subjective increase in the number of echogenic structures within the gallbladder which were variable in size measuring up to 4mm. The lesions were immobile and without acoustic shadowing but did “twinkle” on Doppler. Differential diagnoses remained as gallstones, adenomyomatosis or cholesterolosis. Fetal cholelithiasis has a prevalence of 1% whereas cholesterolosis is much less common and congenital adenomyomatosis of the gallbladder (AMG) extremely rare. With an unclear diagnosis, surveillance is warranted and a further ultrasound has been scheduled for six months' time. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.