Coarse fetal liver calcifications on prenatal imaging: a diagnostic dilemma with uncertain implications

Fetal liver calcifications (FLCs) are relatively common findings on prenatal imaging, typically appearing as punctate, hyperechogenic areas with posterior acoustic shadowing. Although they may suggest genetic, infectious or vascular anomalies, isolated cases are often clinically insignificant. We are reporting a case of a pregnant woman in her late 30s whose routine second-trimester ultrasound revealed isolated, coarse FLCs. Despite their ultrasonographic appearance, prenatal investigations—including karyotyping, infection screening and cystic fibrosis testing—were unremarkable. The pregnancy progressed normally, culminating in the term delivery of a healthy male infant. Postnatal imaging confirmed isolated intrahepatic calcifications with no identifiable aetiology. Early vascular events during development were hypothesised. Prenatal diagnosis of FLCs requires consideration of multiple aetiologies and, consequently, targeted investigation. Once potential causes are excluded, isolated FLCs, even when coarse, do not appear to impact fetal or neonatal outcomes. The literature regarding the characterisation and management of coarse FLCs remains limited.