PRENATAL ULTRASONOGRAPHIC DIAGNOSIS OF FETAL HEPATIC HYPERECHOGENICITIES - CLINICAL-SIGNIFICANCE AND IMPLICATIONS FOR MANAGEMENT

The clinical significance of sonographically detected fetal hepatic hy perechogenicities has not been fully established The aim of this study was to assess various aspects of fetal hepatic hyperechogenicities de tected in utero, including natural history, prenatal investigation and pregnancy outcome. In a retrospective survey of pregnant women presen ting to the ultrasonographic unit five fetuses with a mean gestational age of 20 weeks (range 14-24 weeks) were antenatally diagnosed as hav ing hepatic hyperechogenicities. All cases underwent extensive investi gation to establish the etiology and to determine the spectrum of ultr asonographic presentation. In three fetuses, only parenchymal lesions were found while two had combined lesions: parenchymal and peritoneal. The earliest prenatal ultrasonographic diagnosis was made at 14 weeks ' gestation in a fetus with combined hyperechogenic lesions, which, at 12 weeks' gestation, demonstrated unexplained fetal ascites. Associat ed abnormalities were found in only one fetus in which a solitary pare nchymal lesion was associated with direct communication of the intrahe patic portion of the umbilical vein with the right atrium, and high ou tput cardiac failure. In this case, termination of pregnancy confirmed ischemic hepatic necrosis. In the other four cases, no direct etiolog y could be determined and all four pregnancies continued to term with normal neonatal follow up until 12 months of age. The present data sug gest that in cases of fetal hepatic hyperechogenicities, where apparen t intrauterine infection or neoplasia can be ruled out, a vascular dis ruption phenomenon is a putative etiology. If there are no associated morphological abnormalities or abnormal karyotypes, the prognosis may be favorable.