Hepatic subcapsular flow: An early marker in diagnosing biliary atresia

Rl, Ramesh; Gv, Murthy; Jadhav,; Ravindra, Sindhu

doi:10.4103/0971-3026.155875

Cited by 13 publications

(9 citation statements)

References 8 publications

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“…A similar phenomenon was also observed in Lee’s[ 8 ] and Ramesh’s[ 27 ] studies. These authors reported that patients with BA who had hepatic subcapsular ﬂow on color Doppler US images also had subcapsular telangiectatic vessels on the liver surface at the time of the Kasai procedure.…”

Section: Discussionsupporting

confidence: 87%

Laparoscopic finding of a hepatic subcapsular spider-like telangiectasis sign in biliary atresia

Zhou¹,

Jiang²,

Tang³

et al. 2017

WJG

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AIMTo assess the diagnostic value of a laparoscopic finding of a hepatic subcapsular spider-like telangiectasis (HSST) sign in biliary atresia.METHODSA retrospective study was conducted first and then a validation set was used to investigate the value of an HSST sign in predicting biliary atresia (BA). In the retrospective study, laparoscopic images of the liver surface were reviewed in 126 patients with infantile cholestasis (72 BA patients and 54 non-BA cholestasis patients) and a control group of 38 patients with non-hepatic conditions. Analysis was first made by two observers separately and finally, a consensus conclusion was achieved. Then, the diagnostic value of the HSST sign was validated in an independent cohort including 45 BA and 45 non-BA patients.RESULTSIn the retrospective investigation, an ampliﬁed HSST sign was found in all BA patients, while we were unable to detect the HSST sign in 98.1% of the 54 non-BA patients. There was no HSST sign in any of the control subjects. In the first review, the sensitivity and specificity from one reviewer were 100% and 98.1%, respectively, and the results from the other reviewer were both 100%. The consensus sensitivity and specificity were 100% and 98.1%, respectively. The HSST sign was defined as being composed of several enlarged tortuous spider-like vascular plexuses with two to eight branches distributed on all over the liver surface, which presented as either a concentrated type or a dispersed type. In the independent validation group, the sensitivity, specificity, positive predictive value and negative predictive value of the HSST sign were 100%, 97.8%, 97.8% and 100%, respectively.CONCLUSIONThe HSST sign is characteristic in BA, and laparoscopic exploration for the HSST sign is valuable in the diagnosis of BA.

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Section: Discussionsupporting

confidence: 87%

Laparoscopic finding of a hepatic subcapsular spider-like telangiectasis sign in biliary atresia

Zhou¹,

Jiang²,

Tang³

et al. 2017

WJG

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“…El-Guindi et al[44] in a recent study reported the superiority of demonstration of hepatic subcapsular flow over the other sonographic parameters such as triangular cord sign, GB contractility, GB size and dimensions of hepatic artery. Even when the sonographic hallmark of triangular cord sign could not be satisfactorily demonstrated, presence of hepatic sub capsular flow can be of significant value in sonographic examination[45]. …”

Section: Investigationsmentioning

confidence: 99%

Biliary atresia: Where do we stand now?

Govindarajan

2016

WJH

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The pathway from clinical suspicion to establishing the diagnosis of biliary atresia in a child with jaundice is a daunting task. However, investigations available help to point towards the correct diagnosis in reasonable time frame. Imaging by Sonography has identified several parameters which can be of utility in the diagnostic work up. Comparison of Sonography with imaging by Nuclear medicine can bring out the significant differences and also help in appropriate imaging. The battery of Biochemical tests, available currently, enable better understanding of the line-up of investigations in a given child with neonatal cholestasis. Management protocols enable standardized care with optimal outcome. The place of surgical management in biliary atresia is undisputed, although Kasai procedure and primary liver transplantation have been pitted against each other. This article functions as a platform to bring forth the various dimensions of biliary atresia.

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“…However, IL-12p70 and IL-23 together can drive effector function in memory CD4 + cells and this underpins the pathogenesis of many human inflammatory conditions ( 26 ). IL-23 drives effector function of Th17 cells characterized by production of IL-17A, IL-17F, IL-21, and IL-22 ( 26 ) and the presence of IL-12 reprograms memory Th17 cells into a “Th17/Th1” phenotype that are more aggressive and pathogenic, favoring autoimmune disease progression ( 11 , 27 – 30 ).…”

Section: Introductionmentioning

confidence: 99%

Human Blood CD1c+ Dendritic Cells Promote Th1 and Th17 Effector Function in Memory CD4+ T Cells

et al. 2017

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Dendritic cells (DC) initiate the differentiation of CD4+ helper T cells into effector cells including Th1 and Th17 responses that play an important role in inflammation and autoimmune disease pathogenesis. In mice, Th1 and Th17 responses are regulated by different conventional (c) DC subsets, with cDC1 being the main producers of IL-12p70 and inducers of Th1 responses, while cDC2 produce IL-23 to promote Th17 responses. The role that human DC subsets play in memory CD4+ T cell activation is not known. This study investigated production of Th1 promoting cytokine IL-12p70, and Th17 promoting cytokines, IL-1β, IL-6, and IL-23, by human blood monocytes, CD1c+ DC, CD141+ DC, and plasmacytoid DC and examined their ability to induce Th1 and Th17 responses in memory CD4+ T cells. Human CD1c+ DC produced IL-12p70, IL-1β, IL-6, and IL-23 in response to R848 combined with LPS or poly I:C. CD141+ DC were also capable of producing IL-12p70 and IL-23 but were not as proficient as CD1c+ DC. Activated CD1c+ DC were endowed with the capacity to promote both Th1 and Th17 effector function in memory CD4+ T cells, characterized by high production of interferon-γ, IL-17A, IL-17F, IL-21, and IL-22. These findings support a role for CD1c+ DC in autoimmune inflammation where Th1/Th17 responses play an important role in disease pathogenesis.

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Hepatic subcapsular flow: An early marker in diagnosing biliary atresia

Abstract: We report an interesting sign in the sonological evaluation of neonatal cholestasis, which is hepatic subcapsular flow. Hepatic subcapsular flow is an early and useful marker in diagnosing biliary atresia.

Cited by 13 publications

References 8 publications

Laparoscopic finding of a hepatic subcapsular spider-like telangiectasis sign in biliary atresia

Laparoscopic finding of a hepatic subcapsular spider-like telangiectasis sign in biliary atresia

Biliary atresia: Where do we stand now?

Human Blood CD1c+ Dendritic Cells Promote Th1 and Th17 Effector Function in Memory CD4+ T Cells

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