From the Guidelines
Hepatic calcifications in pediatric patients are most commonly caused by congenital infections, such as toxoplasmosis, as well as other conditions including vascular abnormalities, neoplasms, inflammatory conditions, and metabolic disorders. When hepatic calcifications are detected on imaging, a systematic diagnostic approach should be undertaken to determine the cause. The differential diagnosis includes:
- Congenital infections (TORCH infections - toxoplasmosis, other agents, rubella, cytomegalovirus, and herpes simplex) 1
- Vascular abnormalities (hemangiomas, arteriovenous malformations)
- Neoplasms (hepatoblastoma, metastatic neuroblastoma)
- Inflammatory conditions (tuberculosis, histoplasmosis)
- Metabolic disorders Management depends on the underlying cause, with treatment directed at the specific etiology rather than the calcifications themselves. For infectious causes, appropriate antimicrobial therapy should be initiated; for tumors, surgical resection or chemotherapy may be necessary; and for vascular lesions, observation or intervention based on symptoms. A comprehensive workup typically includes detailed imaging (ultrasound, CT, or MRI), laboratory tests (liver function tests, infectious disease markers), and possibly liver biopsy in selected cases. The prognosis varies widely depending on the underlying cause, with some conditions having excellent outcomes with appropriate treatment while others may have more guarded prognoses. Early detection and prompt management are essential to optimize outcomes in children with hepatic calcifications. In the case of congenital toxoplasmosis, abdominal ultrasonography at birth for intrahepatic calcifications and/or hepatosplenomegaly is recommended 1. It is also important to note that the risk of mother-to-child transmission of toxoplasmosis is higher when the maternal CD4+ T-lymphocyte count is decreased, and cautious monitoring of HIV-infected pregnant women is indicated 1. Overall, a thorough evaluation and prompt management of hepatic calcifications in pediatric patients are crucial to improve outcomes and prevent long-term complications.
From the Research
Causes of Hepatic Calcifications in Pediatric Patients
The causes of hepatic calcifications in pediatric patients can be varied and numerous. Some of the possible causes include:
- Benign and malignant liver masses, pseudomasses, and miscellaneous pathologic abnormalities 2, 3
- Cystic lesions, solid neoplastic masses, and inflammatory focal lesions 3
- Metabolic disorders, unspecified infections, and hepatitis A 4, 5
- Infantile hemangioma, focal nodular hyperplasia (FNH), and focal fatty lesions 6
Diagnostic Approaches
Diagnostic approaches for hepatic calcifications in pediatric patients may involve:
- Radiological procedures such as ultrasound and computer tomography (CT) to diagnose the type of calcifications and the underlying disease 4
- Contrast-enhanced ultrasound (CEUS) and hepatobiliary contrast in MRI to increase specificity in diagnosis 6
- Biopsy and surveillance with imaging and alpha fetoprotein (AFP) to confirm the stability of lesions and determine the diagnosis 6
Age-Related Differences
The causes of hepatic calcifications and acute liver failure in pediatric patients may vary depending on the age and country of origin. For example:
- In developed countries, the leading diagnosis of acute liver failure in children under 1 year is metabolic disorder, while in developing countries it is unspecified infection 5
- In children over 1 year, the leading diagnosis in developed countries is Non-A-B-C Hepatitis, while in developing countries it is Hepatitis A 5