Triangular cord sign and ultrasound features of the gall bladder in infants with biliary atresia

Abstract

The aim of this study was to reassess the accuracy of the triangular cord sign, the triangular cord sign coupled with abnormal gall-bladder length, and an irregular gall-bladder wall in the diagnosis of biliary atresia. The ultrasonograms of 46 infants with cholestatic jaundice were reviewed for the triangular cord sign, gall-bladder length and gall-bladder wall without knowledge of the clinical data. Of the 23 infants with biliary atresia, 22 had the triangular cord sign whereas 17 infants with other causes of cholestatic jaundice did not have the triangular cord sign. The sensitivity, specificity, accuracy and positive predictive value of the triangular cord sign in the diagnosis of biliary atresia were 95.7, 73.9, 84.8 and 78.6%, respectively. The sensitivity, specificity, accuracy and positive predictive value of the triangular cord sign coupled with abnormal gall-bladder length in the diagnosis of biliary atresia were all 95.7%. Gall-bladder wall irregularity was seen in seven of 14 infants (50%) with biliary atresia whose gall bladders contained bile on ultrasound and in two of 22 infants (9.1%) without biliary atresia whose gall bladders contained bile on ultrasound. At the medical centre where this study was performed and where infants present with cholestatic jaundice at an advanced stage, the ultrasonographic triangular cord sign coupled with abnormal gall-bladder length is more reliable than the ultrasonographic triangular cord sign alone or gall-bladder wall irregularity in the diagnosis of biliary atresia.

Ultrasound evaluation of infants suspected to have biliary atresia with emphasis on the triangular cord sign: The Lagos experience

“…Visrutaratna et al [14] claim that the ultrasonographic triangular cord sign coupled with abnormal gallbladder length is more reliable than the ultrasonographic triangular cord sign alone or gallbladder wall irregularity in the diagnosis of biliary atresia as was found in this study where all three subjects that had a positive TC sign on USS, were confirmed at surgery and none of them had gallbladder demonstrated.…”

Definitive exclusion of biliary atresia in infants with cholestatic jaundice: the role of percutaneous cholecysto-cholangiography

“…Endoscopic retrograde cholangiopancreatography (ERCP) has high sensitivity, but it requires general anesthesia in infants and depends on equipment and technical expertise that is rarely available in many pediatric centers [10,11]. The US detection of the 'triangular cord' sign has very high accuracy in experienced hands, although some authors have reported sensitivity and specificity as low as 80 and 74%, respectively [12,13]. US has also been used to determine the presence or absence of the extrahepatic bile duct with similar accuracy as the triangular cord sign [14].…”

Prise en charge de la cholestase à début néonatal chez l’enfant : comment pouvons-nous faire mieux ?

“…Il s'agit de la polysplénie, du signe du « cône fibreux ». Le triangle hyperéchogène au hile du foie a une sensibilité, une spécificité et une valeur prédictive positive très élevées de l'ordre de 95,7 ; 73,9 ; 84,8 et 78,6 % respectivement pour le diagnostic de l'AVB [20][21][22][23][24][25][26]. Les comptes rendus des échographistes étaient incomplets pour l'AV.…”