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Published on: August 19, 2020
US approach to jaundice in infants and children
J A Gubernick1, H K Rosenberg, H Ilaslan
1Department of Radiology, Albert Einstein Medical Center, Philadelphia, PA 19141-3098, USA.
Insights
High-resolution ultrasonography (US) helps distinguish obstructive from non-obstructive jaundice in children. Further tests may be needed to confirm diagnoses like hepatitis or biliary atresia.
Area of Science:
- Pediatric Radiology
- Gastroenterology
- Medical Imaging
Background:
- Neonatal jaundice is common, affecting up to 60% of term and 80% of preterm infants.
- Persistent jaundice beyond two weeks necessitates evaluation to identify underlying causes.
- Common causes include hepatitis, biliary atresia, and choledochal cysts, presenting similar hepatic echotexture patterns.
Purpose of the Study:
- To evaluate the role of high-resolution real-time ultrasonography (US) in differentiating obstructive and non-obstructive causes of jaundice in pediatric patients.
- To assess the utility of US in identifying specific conditions like hepatitis, biliary atresia, and choledochal cysts.
- To determine the effectiveness of US in detecting biliary duct stones and inspissated bile.
Main Methods:
- High-resolution real-time ultrasonography was employed for imaging.
- Analysis focused on hepatic echotexture, presence of inspissated bile, and biliary duct stones.
- Comparison with other diagnostic modalities like hepatic scintigraphy and liver biopsy was considered.
Main Results:
- Ultrasonography effectively differentiates obstructive from non-obstructive jaundice, independent of liver function.
- US can demonstrate inspissated bile and biliary duct stones, crucial for diagnosis.
- While US shows characteristic patterns, further investigations like scintigraphy or biopsy may be required for definitive diagnosis.
Conclusions:
- High-resolution real-time ultrasonography is a valuable, non-invasive tool for evaluating pediatric jaundice.
- US aids in narrowing the differential diagnosis, guiding further diagnostic steps.
- It plays a key role in identifying biliary abnormalities and stones in infants and children.
Abstract:
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 secondary to obstructive congenital anomalies of the biliary tract, total parenteral nutrition, furosemide treatment, phototherapy, dehydration, infection, hemolytic anemia, and short-gut syndrome, whereas in older children, stones are usually associated with sickle cell disease, bowel resection, hemolytic anemia, and choledochal cyst. Jaundice in infants and children may also be due to cirrhosis, benign strictures, and neoplastic processes.
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