Ultrasound Division, ASL Roma B, Rome, Italy.

Case report
Postulated causes of fetal gallstones include hemolytic disease, cholestasis, and maternal drug use. Most studies report no associated fetal abnormalities [1,2]. The detection of gallstones or sludge in the fetus is typically not associated with postnatal clinical sequelae (unlike cholelithiasis in children). In many cases, the stones resolve before or soon after delivery, possibly due to alterations in bile metabolism.

Following images and video show two cases of biliary sludge observed in the third trimester in patients that were followed from the first trimester. There were no fetal anomalies present. Fetal growth, amniotic fluid volume and fetal Doppler were normal. Healthy neonates were born in both cases.The patient of the case 1 was lost from follow up after birth, while in case 2, the sludge was no more visible three months after delivery.

Case 1

Images 1, 2, 3, and video 1: Biliary sludge at 38 weeks of gestation.

Case 2

Images 4, 5: Biliary sludge that was seen at 34 and 38 weeks of gestation.

References

1. Devonald KJ, Ellwood DA, Colditz PB. The variable appearances of fetal gallstones. J Ultrasound Med 1992;11:579–585.
2. Brown DL, Teele RL, Doubilet PM, Di Salvo DN, Benson CB, Van Alstyne GA. Echogenic material in the fetal gallbladder: sonographic and clinical observations. Radiology1992;182:73–76.