1Department of Diagnositc Radiology, Keimyung University School of Medicine, Korea. 2Department of Pathology, Keimyung University School of Medicine, Korea.
Published online: January 1, 2001.
ABSTRACT
PURPOSE: To demonstrate the obliterated extrahepatic fibrous ductal remnant (EHFDR) at the porta hepatis of biliary atresia by using ultrasound and to correlate with surgical findings. MATERIALS & METHODS : Prospective sonographic study was performed in 31 infants presented with acholic stool and persistent conjugated hyperbilirubinemia before the age of 4 months. Special attention was paid to the porta hepatis for the evaluation of the presence or absence of a triangular or thick, band-like echogenic lesion along the portal vein on transverse or longitudinal scan. We hypothesized that the echogenic lesion would represent the EHFDR at the porta hepatis of biliary atresia and the presence of this finding was interpreted as possible biliary atresia. We measured the size of the echogenic lesion by "width x thickness"(mm) on transverse scan. We evaluated the presence or absence, pattern, and size of the EHFDR in the infants with biliary atresia who underwent surgery. RESULTS: Thirty-one infants consisted of 12 infants with biliary atresia (all proven by Kasai portoenterostomy and wedge liver biopsy) and 19 infants with neonatal hepatitis (biopsy proven 12 and clinically diagnosed seven infants). The echogenic lesion at the porta hepatis was present in ten (83%) of the 12 infants with biliary atresia, but none of the infants with neonatal hepatitis. The EHFDR were present at the porta hepatis of all infants with biliary atresia, and all triangular-cone shaped fibrous mass pattern at surgery. The mean size of the echogenic lesion was 18.2 x 8.2(range, 10~26 x 5~12) mm and that of the EHFDR was 13.2 x 6.1 (range, 7~25 x 5~10) mm. The sizes of two EHFDR which did not show the echogenic lesion on ultrasound were 7 x 5 mm, and 10 x 5 mm, respectively. CONCLUSION: The extrahepatic fibrous ductal remnant of biliary atresia would be represented by the echogenic lesion at the porta hepatis, and this sonographic finding would be helpful for the differential diagnosis of biliary atresia from neonatal hepatitis.
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