Biliary Atresia: Ultrasound Diagnosis, Gallbladder Assessment and Associated Findings

Clinical Presentation

Biliary atresia is more common in males and may be congenital or result from inflammation of the hepatobiliary system. The disease may affect intrahepatic or extrahepatic bile ducts and may or may not involve the gallbladder, although the form with absent gallbladder is most frequent. Clinical signs in the newborn include: persistent jaundice, acholic (colorless) stools, dark urine, and abdominal distension due to hepatomegaly. Early surgical correction (Kasai portoenterostomy) is important [to be clarified].

Ultrasound Findings of the Liver and Gallbladder

In the described clinical case: a 5-day-old newborn with direct hyperbilirubinemia of unclear etiology had an enlarged liver with homogeneous echotexture; ductal obstruction, congestion, and inflammation were noted. The gallbladder was contracted and measured less than 1 cm (examination performed immediately after feeding).

One should remember the so-called pseudogallbladder — an abnormally formed gallbladder that is sometimes seen in newborns with biliary atresia. This is a described visualization pitfall (pseudo gallbladder sign).

Feeding Trial

Reduction in gallbladder size following milk feeding indicates normal patency of the common hepatic duct and common bile duct and suggests neonatal hepatitis rather than biliary atresia.

Additional Abdominal Assessment

When biliary atresia is suspected, the abdomen should be carefully evaluated for the presence of polysplenia, as this may be associated with this condition.

Triangular Cord Sign

[To be clarified] — the provided fragments do not contain a description and criteria for the triangular cord sign, nor ESPGHAN recommendations.