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Titolo:
ULTRASONOGRAPHIC TRIANGULAR CORD - THE MOST DEFINITIVE FINDING FOR NONINVASIVE DIAGNOSIS OF EXTRAHEPATIC BILIARY ATRESIA
Autore:
CHOI SO; PARK WH; LEE HJ;
Indirizzi:
KEIMYUNG UNIV,DONGSAN MED CTR,DEPT PEDIAT SURG,SCH MED,194 DONG SAN DONG TAEGU 700310 SOUTH KOREA KEIMYUNG UNIV,DONGSAN MED CTR,DEPT RADIOL TAEGU 700310 SOUTH KOREA
Titolo Testata:
European journal of pediatric surgery
fascicolo: 1, volume: 8, anno: 1998,
pagine: 12 - 16
SICI:
0939-7248(1998)8:1<12:UTC-TM>2.0.ZU;2-H
Fonte:
ISI
Lingua:
ENG
Soggetto:
NEONATAL CHOLESTASIS; SCINTIGRAPHY;
Keywords:
BILIARY ATRESIA; ULTRASOUND; NEONATAL HEPATITIS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
13
Recensione:
Indirizzi per estratti:
Citazione:
S.O. Choi et al., "ULTRASONOGRAPHIC TRIANGULAR CORD - THE MOST DEFINITIVE FINDING FOR NONINVASIVE DIAGNOSIS OF EXTRAHEPATIC BILIARY ATRESIA", European journal of pediatric surgery, 8(1), 1998, pp. 12-16

Abstract

Early diagnosis of extrahepatic biliary atresia (EHBA) is very important for a successful bile drainage procedure. An urgent and extensive investigation is warranted to make a differential diagnosis of EHBA from other cholestatic disease, especially neonatal hepatitis (NH). The diagnosis may be made by laparotomy with cholangiogram and liver biopsy but these procedure are invasive. Because a cone-shaped fibrous tissue was always found at the porta hepatis during Kasai's procedure and that type of fibrous tissue has never been seen in other types of cholestatic jaundice, the authors have used ultrasonography (US) to detectfibrous remnants at the porta hepatis in infants clinically suspectedof having EHBA and identified a triangular-or tubular-shaped echogenic density in the bifurcation of the portal vein at the porta hepatis in EHBA and called it an ultrasonographic ''triangular cord (TC)''. Theauthors determined that the presence of TC denoted the EHBA. On the other hand, nonvisualization of TC was interpreted as consistent with NH. In the present study, the authors reviewed ultrasonographic examination and hepatobiliary scintigraphy in a series of 41 infants suspected of having EHBA or NH. The TC was identified in thirteen infants. In twelve of thirteen infants with TC found by US, the diagnosis of EHBA was confirmed at the time of Kasai's Roux-en-Y hepatoportoje-junostomyoperation. The remaining one died at 15 months of age without having treatment. TC was not visualized in 28 infants. Twenty-seven of 28 infants with absent TC improved clinically through medical treatment for NH, The other, diagnosed to have Nti by needle and wedge liver biopsies, eventually showed a TC on follow-up US examination performed 40 days after the initial examinations. Moreover, follow-up percutaneous liver biopsy specimen showed typical findings of biliary atresia with bile duct proliferation and portal fibrosis. The patient underwent a Kasai hepatoportoenterostomy. On review of the hepatobiliary scintigraphy,all 13 infants with TC had no intestinal excretion of isotope. Thirteen of 28 infants (46 %) without TC also had no intestinal excretion ofisotope in the 24hour follow-up but all of them were confirmed to have NH by percutaneous liver biopsy and their subsequent clinical courseconfirmed NH with the detection of bile in their stool except one. Onthe basis of these results, the authors conclude that ultrasonographic TC is a very specific finding representing the fibrous cone at the porta hepatis and is a quick, simple, and definitive tool in the noninvasive diagnosis of EHBA. If TC is visualized, no further studies are necessary and exploratory-laparotomy can be done. If TC is not visualized, hepatobiliary scintigraphy is recommended to demonstrate bile ductpatency. Percutaneous liver biopsy is only required if neither TC norintestinal excretion of isotope is seen, However, early exploration or close US follow-up study is recommended in any patient suspected of having EHBA clinically, even if liver biopsy confirms the presence of NH.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 01/10/20 alle ore 16:16:58