Nonvisualization of the fetal gallbladder by second-trimester ultrasound scan: strategy of clinical management based on four examples.
OBJECTIVE
When the fetal gallbladder is not seen at ultrasound (US) scan, to propose a diagnostic method of differentiating fetuses who are healthy or have minor anomalies from fetuses with severe anomalies requiring intensive management.


METHODS
We present four clinical cases illustrating this variability, together with additional examinations: karyotyping, screening for cystic fibrosis mutations, amniotic fluid digestive enzyme activities.


RESULTS
The four examples we present-biliary duct atresia, biliary agenesis, gallbladder reveal at birth, and cystic fibrosis-illustrate the difficulties of making both diagnosis and prognosis prenatally when the gallbladder is not visualized. Laboratory assays allowed prenatal management.


CONCLUSIONS
Failure to visualize the gallbladder prenatally may indicate fetal diseases of highly variable prognosis, but may also sometimes be followed by postnatal visualization in a child free of any disease. Prenatal management could help in defining diagnosis and prognosis.
Boughanim
Mathias
M
Gynécologie-Obstétrique, Hôpital Necker, AP-HP, Paris, France.
Benachi
Alexandra
A
Dreux
Sophie
S
Delahaye
Sophie
S
Muller
Françoise
F
D000328:Adult; D000469:Alkaline Phosphatase / Q000032:analysis; D000653:Amniotic Fluid / Q000201:enzymology; D001652:Bile Ducts / Q000002:abnormalities; D003550:Cystic Fibrosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000196:embryology; D005260:Female; D005704:Gallbladder / Q000002:abnormalities / Q000000981:diagnostic imaging* / Q000196:embryology; D005865:Gestational Age; D006801:Humans; D007931:Leucyl Aminopeptidase / Q000032:analysis; D008297:Male; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D016216:Ultrasonography, Prenatal; D005723:gamma-Glutamyltransferase / Q000032:analysis
D005723:gamma-Glutamyltransferase; D000469:Alkaline Phosphatase; D007931:Leucyl Aminopeptidase