Role of Abdominal Sonography in the Preoperative Diagnosis of Extrahepatic Biliary Atresia in Infants Younger Than 90 Days

Abstract

Comprehensive sonographic evaluation can help in segregating infants at high risk of EHBA from those at low risk.

Common misdiagnoses of biliary atresia

“…Contractile gallbladder was defined by the change in gallbladder dimensions on ultrasonography 30 min postprandial compared with its basal size after 4 h of fasting. The gallbladder was considered abnormal if no change of its dimensions was observed, if its length was less than 20.5 mm [5], or if it was not visualized [8]. Hepatic histopathological features in the form of portal fibrosis, ductular proliferation, bile plugs, intracellular cholestasis, portal cellular infiltrate, and multinucleated giant hepatocyte were also revised.…”

Contribution of acoustic radiation force impulse (ARFI) elastography to the ultrasound diagnosis of biliary atresia

“…US criteria suggesting biliary atresia in the literature are the following: absent or small gallbladder, triangular cord sign and hepatic artery-portal vein diameter ratio [8,20,21]. Although some authors describe the role of hepatic subcaspular flow on color Doppler [22], we did not record this sign in our study.…”

“…To date, several sonographic criteria (gallblader size, triangular cord sign, splenomegaly, hepatic artery-portal vein ratio, hepatic subcapsular flow on color Doppler) may point to biliary atresia, but none is diagnostic [8]. Likewise, routine serum measurements are of limited sensitivity and specificity [9].…”

Ultrasonographic findings of type IIIa biliary atresia

“…However, the two major causes accounting for 60%-90% of all neonatal cholestasis are neonatal hepatitis and biliary atresia [1]. Discrimination between these two entities is very important, since they require completely different treatment approaches-medical treatment for hepatitis and surgery for biliary atresia.…”

“…The concept that a younger age at the diagnosis of and surgery for biliary atresia leads to a better outcome has been generally accepted [1,5-14], while some of the published data have revealed that patient age has no significance or sometimes even a negative effect on the prognosis [15,16]. However, when it comes to type III biliary atresia, the negative effect of older age seems more obvious [9].…”