Ultrasound Scanning in Infants with Biliary Atresia: The Different Implications of Biliary Tract Features and Liver Echostructure

Abstract

Although the triangular cord was visualized in one-fourth of the infants with biliary atresia, abnormalities of the gallbladder on ultrasound (absence or abnormalities of length/shape) were detected in 83 % of the patients. Therefore, ultrasound evaluation of the liver and biliary tree plays an important role in suspecting biliary atresia. On the other hand, a low correspondence between liver echostructure aspects and the presence and severity of fibrosis at liver biopsy was identified. Therefore, severe liver disease in infants with biliary atresia cannot be excluded only on the basis of ultrasound findings.

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 …”

Italian guidelines for the management and treatment of neonatal cholestasis

“…Abdominal ultrasound is an important tool in the diagnostic work-up of neonatal cholestasis and is the most useful initial imaging study in the evaluation of neonatal cholestasis [ 14 ]. It can assess the size and appearance of the liver and gallbladder--including visualization of gallstones and biliary sludging.…”

Neonatal Cholestasis: A Pandora’s Box

“…Joint recommendation by the North American Society for Pediatric Gastroenterology, 3,8,15–35 Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition 2016, has definedabnormal direct/conjugated bilirubin as a serum value >1.0 mg/dL (17 mmol/L), because it is physiologically and clinically complex to consider incorporating consideration of whether or not the direct fraction exceeds 20% of the total bilirubin level as mentioned in some publications. 14 …”