Imaging in neonatal cholestasis

Abstract

Babies with neonatal cholestasis (NC) present with jaundice, passage of dark urine with or without pale stools. Any infant presenting beyond 2 weeks of age with these symptoms should be immediately evaluated.1,2 NC is constituted by a number of disorders that need segregation at clinical and investigative levels for specific diagnosis and treatment (Table 1).3,4 The role of imaging in differential diagnosis and follow-up is highlighted here. Various imaging techniques used are ultrasonography, magnetic resonance cholangiopancreatogra- phy (MRCP), hepatobiliary scintigraphy and per-operative cholangiography. Imaging is currently used for a) diagnosing choledochal cyst by ultrasonography b) suggestion of biliary atresia (BA) by ultrasonography c) hepatobiliary scintigraphy to rule out BA and also post-operatively for evaluation of cholangitis d) per-operative cholangiogram for confirmation of BA, type of atresia, and groups of BA when associated with hepatobiliary cysts and e) post-Kasai evaluation of recurrent cholangitis.