High-resolution real-time ultrasonography (US) serves as an important tool for differentiation of obstructive and nonobstructive causes of jaundice in infants and children, independent of liver function. Unconjugated hyperbilirubinemia occurs in approximately 60% of normal term infants and in 80% of preterm infants. Persistence of neonatal jaundice beyond 2 weeks of age demands US evaluation to differentiate between the three most common causes: hepatitis, biliary atresia, and choledochal cyst. In all three conditions, the hepatic echotexture is diffusely coarse and hyperechoic, but this appearance may be seen in a variety of hepatic inflammatory, obstructive, and metabolic processes. Thus, hepatic scintigraphy and at times percutaneous liver biopsy are necessary to narrow the differential diagnosis and to identify patients who require more invasive techniques (eg, intraoperative cholangiography). US is useful for demonstrating inspissated bile and biliary duct stones. In infants, stones are usually secon...

US Approach to Jaundice in Infants and Children

The objective of this study was to evaluate the association of intrahepatic cholestasis, pulmonary stenosis, and hyperlipemia with osseous and renal abnormalities in Alagille's syndrome. A total of 37 patients (25 males and 12 females) with ages ranging between 8 months and 27 years were included. Clinical records as well as radiological and ultrasonographic studies were reviewed. Chronic cholestasis was observed in all patients. Thirteen had favorable clinical outcome and normal hepatic sonograms. Clinical and sonographic evidence of portal hypertension was found in 13 patients and of cirrhosis in 8 patients. The remaining 3 patients required hepatic transplantation due to severe cholestasis. Hyperlipemia correlated with hepatic malfunction. Pulmonary stenosis and renal hypoplasia were the most frequently associated abnormalities. All patients showed a peculiar facies. Abnormal “butterfly” vertebrae were present in 18 patients and ulnar or phalangeal shortening in 11 patients. Ultrasonography allowed hepatobiliary disease assessment and helped to establish indications for hepatic transplantation. Renal and osseous abnormalities were not specific but in the appropriate clinical setting reinforced the diagnosis.

Syndrome of Alagille: radiological and sonographic findingsA review of 37 cases

In Alagille syndrome, routine follow-up imaging of the liver plays an important role in detecting early parenchymal changes and to evaluate portal hypertension. Modern contrast-enhanced imaging methods not only allow early detection of focal liver lesions, but also enable further characterization of their nature and guide biopsy procedures. We present the US and MR imaging findings of hepatocellular carcinoma and a regenerating nodule in a 3-year-old child with Alagille syndrome.

/pdf/hepatocellular-carcinoma-and-regenerating-nodule-in-a-3-year-4fp882j6x9.pdf

Hepatocellular carcinoma and regenerating nodule in a 3-year-old child with Alagille syndrome

In the neonate with cholestasis, clinical features and standard tests of liver function frequently cannot distinguish between diseases of the hepatocyte and those of the biliary tree. Therefore, a multidisciplinary approach to diagnosis is required. A priority in investigation is the identification of patients requiring surgery. A correct diagnosis regarding the need for surgery can be made in the majority of cases after synthesis of information obtained from abdominal sonography, hepatobiliary scintigraphy, and liver biopsy. Intraoperative cholangiography is performed routinely to precisely delineate the anatomy of the intrahepatic and extrahepatic bile ducts.

Imaging of neonatal cholestasis

Applications of ultrasound in the neonatal abdomen.

The sonograms of 12 neonates and infants with documented nonneoplastic parenchymal liver diseases, including cytomegalovirus infection, biliary atresia, alpha 1-antitrypsin deficiency, nesidioblastosis, Alagille association, microabscesses, and idiopathic neonatal jaundice, were analyzed by various sonographic criteria. Nine (75%) of the hepatic sonograms were abnormal; however, most showed only one sonographic abnormality. Although it was not possible to distinguish one condition from another sonographically, focal areas of heterogeneity simulating mass lesions and accentuated periportal brightness were the most notable abnormal features. The prime indication for hepatic sonography in this age group continues to be the differentiation of obstructive from nonobstructive jaundice. Nonetheless, when obstruction has been excluded, sonography may demonstrate the presence of hepatic parenchymal disease and provide a noninvasive means for following its course over time.

Sonographic features of hepatocellular disease in neonates and infants

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Sonographic features of hepatocellular disease in neonates and infants