Echogenic Content in the Fetal Gallbladder: Systematic Review of Ultrasound Features and Clinical Outcome

It is rare to detect echogenic content in the fetal gallbladder. The etiology, natural course, and prognosis of this condition remain unclear. In addition to providing a systematic review of this topic, we suggest a plan for patient follow-up. From a total of 100 database entries identified in PubMed, EMBASE, and ICTRP reviews, we selected 34 studies in which we investigated the ultrasound features and outcome of this condition. There were 226 fetuses with gallbladder echogenic content identified. Seventy-two fetuses were found to have biliary sludge; thirty cases had a single hyperechogenic focus, and one hundred fetuses had multiple foci in the gallbladder. There were 16 cases of distal shadowing, 37 fetuses with comet tail and twinkling, and 26 cases with no acoustic artifacts. Nine cases of spontaneous resolution before birth have been documented; nine fetuses exhibited no echogenic content at birth, and 138 cases of resolution of echogenic content within the first year of life have been described. Typically, the condition resolves spontaneously during the postnatal period. After adequately reassuring the parents, the patients should be monitored for spontaneous resolution; medical or surgical intervention is not indicated. Asymptomatic patients can be managed with a wait-and-see strategy.

Automated summary

It is uncommon to find echogenic content in the fetal gallbladder, and the cause, course, and prognosis of this condition are unclear. After reviewing 34 studies, we suggest a follow-up plan for patients with this condition. Among 226 fetuses identified, 72 had biliary sludge, 30 had a single hyperechogenic focus, and 100 had multiple foci. Other ultrasound features included distal shadowing (16 cases), comet tail and twinkling (37 cases), and no acoustic artifacts (26 cases). Spontaneous resolution before birth was documented in 9 cases, while 9 fetuses had no echogenic content at birth, and 138 cases resolved within the first year of life. In most cases, the condition resolves spontaneously in the postnatal period, and medical or surgical intervention is not necessary. Asymptomatic patients can be managed with a wait-and-see approach.