Neonatal hepatic calcification in subcapsular haematoma with hydrops fetalis

Abstract

There are many causes of fetal and infant hepatic calcification. We present two cases of hepatic calcification in a subcapsular haematoma in neonates with hydrops fetalis and chromosomal abnormalities. We do not believe that such an association has been described previously. A 22-year-old woman presented at 30 weeks gestation with polyhydramnios. An ultrasound scan at 14 weeks had shown no abnormality. A scan at 30 weeks showed gross fetal ascites and a diagnosis of non-Rhesus hydrops was made. The pregnancy was allowed to continue and a normal vaginal delivery occurred at 33 weeks. A female infant with external features of Down's syndrome was delivered. Chest and abdominal radiographs taken on the first day showed areas of reticular calcification in the right upper quadrant (Fig. 1). An ultrasound examination on the fourth day showed this calcification to lie on the liver surface and to be concentrated mainly around the porta hepatis. There was gross ascites but no other areas of calcification could be seen (Fig. 2). An ultrasound scan of the brain was normal. There was no growth of organisms from blood or ascitic fluid and antibody titres for varicella and toxoplasmosis, rubella, cytomegalovirus and herpes simplex (TORCH) complex viruses were negative. On the fifth day of life she became cyanotic and died. Trisomy 21 was confirmed cytogenetically. A 27-year-old woman presented at 18 weeks gestation for a routine antenatal ultrasound scan.