2132: Practical ultrasonographic approach in differential diagnosis of biliary atresia and neonatal hepatitis

Abstract

Objectives: To assess the usefulness of US in differential diagnosis of biliary atresia (BA) from neonatal hepatitis (NH) focused on the gallbladder (GB) and the porta hepatis (PH). Methods: Sixty-seven infants who were suspected of having BA or NH (mean age:60.3 d, M:F = 34:33) were evaluated using US focused on the GB and the PH. An atretic GB defined as a small (<2 cm in length) GB with irregular contour, triangular cord (TC), hypertrophy of the hepatic artery (HHA, > 1.5 mm), and bile cyst were used as US criteria for BA. Visualization of the common bile duct (CBD) was thought to be a finding excluding BA. If the findings of the GB and the PH were discordant, we followed US criteria of the PH. BA (n = 38) was confirmed surgically. Results: Thirty patients (79%) with BA demonstrated concordant US findings in the GB and the PH. Six patients with BA who showed non-atretic GB demonstrated TC (n = 6) and HHA (n = 5). The two false-negatives showed a patent CBD. Six patients with NH who had atretic GB demonstrated CBD. Sensitivity and specificity of US were 95% and 97%, respectively. Conclusions: US of the GB and the PH together can be a useful screening modality for the diagnosis of BA.