Ultrasonic diagnosis of biliary atresia: A retrospective analysis of 20 patients

Abstract

AIM:To investigate the clinical value of ultrasonographic diagnosis of biliary atresia (BA), a retrospective analysis of the sonogram of 20 children with BA was undertaken. METHODS: Ultrasonography (US) was performed in 20 neonates and infants with BA, which was confirmed with cholangiography by operation or abdominoscopy. The presence of triangular cord, the size and echo of liver, the changes in empty stomach gallbladder and postprandial gallbladder were observed and recorded. RESULTS: The triangular cord could be observed at the porta hepatis (thickness: 0.3-0.6 cm) in 10 cases. Smaller triangular cord (0.2-0.26 cm) can be observed in 3 cases. The gallbladder was not observed in 2 cases, and 1 case showed a streak gallbladder without capsular space. The gallbladders of 15 cases were flat and small. The gallbladders of 2 cases were of normal size and appearance, however, there was no postprandial contraction. The livers of all cases showed hepatomegaly and heterogeneous echogenicity. Statistical analysis was performed to compare the hepatomegaly and heterogeneous echogenicity and the stage of hepatic fibrosis. CONCLUSION:The presence of the triangular cord at the porta hepatis is specific. However, it is not the only diagnostic criterion, since flat and small gallbladder and poor contraction are also of important diagnostic and differential diagnostic significance. The degree of hepatomegaly and heterogeneous echogenicity is proportional with liver fibrosis, and able to indicate the duration of course and prognosis.

Diagnostic Performance of Sonographic Features in Patients With Biliary Atresia: A Systematic Review and Meta‐analysis

“…Searches of the bibliographies of these articles identified no additional eligible studies. Of these 49 articles, 32 were further excluded after reviewing the full text: 13 studies that were not in the field of interest (6 studies that only included minor sonographic features, 4 studies that were associated with surgery, 2 studies that were related to choledochal cysts, and 1 study that included clinical findings of biliary atresia), 11 studies with a partially overlapping patient cohort, 5 studies with insufficient data to construct a diagnostic 2 × 2 table, 1 study with nonconsecutive patients, 1 study that included only infants younger than 90 days, and 1 non‐English article . Finally, 17 eligible studies, which included a total sample size of 1444 patients, were finally included in our meta‐analysis …”

Biliary atresia: Where do we stand now?

“…Findings pertaining to GB on sonography can be absent/non visualized GB, irregular contour of GB, small shrunken GB, non contractile GB despite 4 h of fasting, cystic structure replacing GB and absent echogenic mucosal lining of GB. The liver echotexture signifying the presence of cirrhosis is another finding useful on sonography for prognostication[39]. At a cut off GB length of 1.5 cm, high index of suspicion for biliary atresia to be kept while evaluating a baby with neonatal cholestasis[40].…”

Biliary Atresia: 50 Years after the First Kasai

“…It needs to be performed after 8 to 12 hours fasting, with BA being suspected if the gallbladder is shrunken despite the absence of feeding, if the liver hilum is hyperechogenic (“triangular cord sign”), or if there is a cyst at the liver hilum without bile duct dilatation [44]. Polysplenia, a preduodenal portal vein, or absence of the retro-hepatic vena cava may be found in syndromic BA babies.…”