Postnatal outcomes of referred cases with abnormal ultrasound findings of fetal gall bladder and cyst in the fetal liver.

Objective: To evaluate the postnatal outcomes of referred cases with abnormal findings in the fetal gallbladder (GB) or cysts in the fetal liver.

Methods: This retrospective study included pregnant women referred to a tertiary referral unit, the fetal therapy center at Ulsan Asan Medical Center in Korea, between June 2005 and October 2022. Persistent non-visualization of the fetal gallbladder (NVFGB) was defined as non-visualization at least twice using an ultrasound scan. Antenatal ultrasound findings were obtained from the medical records, and the clinical, radiological, and surgical findings of the babies were reviewed.

Results: A total of 113 referred patients were evaluated. Most enlarged and small GBs were identified as normal or GB stones, sludge, septate GB, or choledochal cysts (CDC). NVFGB was identified postnatally in 77.5% of cases. Persistent NVFGB was identified postnatally as biliary atresia (3/14; 21.4%), hepatic parenchymal disease with cholestasis (2/14; 14.2%), or isolated GB agenesis (6/14; 42.8%). The majority of cysts in the fetal liver cases with visualization of the fetal GB were identified as CDC. Half of the patients (2/4) with CDC who underwent NVFGB were confirmed to have biliary atresia.

Conclusion: Except for persistent NVFGB, most abnormal ultrasound findings in fetal GB were associated with good postnatal outcomes. Cysts in the fetal liver with visualization of the fetal GB did not result in serious adverse outcomes. NVFGB, especially persistent NVFGB with or without cysts in the fetal liver, should be followed up closely prenatally and postnatally.