Abdominal Calcifications
Karen Y. Oh, MD
DIFFERENTIAL DIAGNOSIS
Common
Meconium Peritonitis, Pseudocyst
Gallstones
Hepatic Calcifications
Less Common
Intraluminal Calcified Meconium
Rare but Important
Teratoma
Fetus-in-Fetu
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Echogenic foci within fetal abdomen
May not have shadowing
Can be punctate or irregularly shaped
Differential diagnosis for etiology based on location of calcifications
Liver
Intraparenchymal vs. liver capsule
Biliary
Bowel
Intraluminal vs. extraluminal
Peritoneum
Abdominal mass
Look for any other associated findings for clues
Intracranial calcifications
Infection
Abnormal bowel
Meconium peritonitis
Anal dimple absent in anal atresia
Fluid collections
Ascites and pseudocysts with meconium peritonitis
Soft tissue mass
Teratoma
Fetus-in-fetu
Other fetal abdominal tumors do not typically calcify
Fetal anomalies
Helpful Clues for Common Diagnoses
Meconium Peritonitis, Pseudocyst
Chemical peritonitis due to intrauterine bowel perforation
Intraperitoneal calcifications most specific finding
Ascites
Loculated fluid collection (pseudocyst) may also be present
Walled-off perforation
Contents have variable echogenicity
Walls often thick and may calcify
Dilated bowel present when secondary to obstruction
Not typical when secondary to ischemic bowel perforation
Gallstones
Echogenic calcifications in the gallbladder
Shadowing may be present but not necessary to diagnose stones
“Comet tail” artifact sometimes present
Mobile
Not usually seen with biliary dilation
Calcifications not always dependent, and some may be within gallbladder wall
Most often seen 3rd trimester
Incidental finding during routine scan
If gallbladder is contracted, gallstones may mimic hepatic calcification
Focal linear area of echoes rather than diffusely spread through liver
Diagnosis more easily made when gallbladder filled
If calcifications seen in typical location of gallbladder, look again later during scan
When gallbladder fills, bile will outline stones
Usually spontaneously resolves within first year of life
Postnatal ultrasound can confirm presence of stones
Typically infants are asymptomatic
Hepatic Calcifications
Intrahepatic, scattered, echogenic foci
Seen with infection
Association with chromosomal anomalies
Shadowing with larger calcifications
Occasionally seen incidentally, without known clinical consequences
Exclude other anatomic abnormalities
Exclude infectious etiology
If isolated, most neonates will be asymptomatic
Capsular calcifications more often related to meconium peritonitis
Most commonly seen at liver dome or undersurface of liver
Look for other calcifications in peritoneum
Helpful Clues for Less Common Diagnoses
Intraluminal Calcified Meconium
Calcified, mobile material within bowel (“marbles”)
Generally occur in setting of anal atresia with associated urinary tract fistula/anomalies
Urine mixes with meconium to cause calcifications
Additional findings of anal atresia
Absent anal dimple
Dilated bowel (usually only seen in 3rd trimester, if present)
May go undetected prenatally
Occasionally enteroliths form due to stasis of bowel contents
Look for other anomalies in VACTERL syndrome
Vertebral, anal atresia, cardiac, tracheo-esophageal fistula, renal, limb
Helpful Clues for Rare Diagnoses
Teratoma
3 germ cell layers present
Arise from growth of pluripotent stem cells without organization
Can have malignant potential
In spectrum with fetus-in-fetu
Fetus-in-fetu classically defined by presence of spine
Teratoma may still have limbs, digits, other organs
Can originate from retroperitoneum, as well as multiple other sites along midline
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