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Biliary atresia: making the diagnosis by the gallbladder ghost triad.

Anne Poh Ann Tan Kendrick1, Kong Boo Phua, Boo Chye Ooi

  • 1Department of Diagnostic Imaging, Kandang Kerbau Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore. annetan@kkh.com.sg

Pediatric Radiology
|April 16, 2003
PubMed
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The gallbladder ghost triad is a highly accurate ultrasound finding for diagnosing extrahepatic biliary atresia (BA) in infants. This sign aids in early detection, improving outcomes for this serious liver condition.

Area of Science:

  • Pediatric Radiology
  • Gastroenterology
  • Neonatal Imaging

Background:

  • Extrahepatic biliary atresia (BA) is a critical neonatal liver disease requiring early diagnosis.
  • Sonography is a key imaging modality for evaluating cholestatic jaundice in infants.
  • Accurate diagnostic criteria are essential for timely intervention.

Purpose of the Study:

  • To define the sonographic "gallbladder ghost triad".
  • To assess the diagnostic accuracy of the gallbladder ghost triad for extrahepatic biliary atresia (BA).

Main Methods:

  • Sonographic examination of 217 infants (aged 2-12 weeks) with cholestatic jaundice.
  • Defined the gallbladder ghost triad: gallbladder length <1.9 cm, indistinct mucosal lining, and irregular contour.
  • Correlated sonographic findings with surgical and histological BA diagnoses.

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Main Results:

  • The gallbladder ghost triad was present in 30 of 31 infants with BA (97% sensitivity).
  • No false-positive cases of the triad were observed.
  • Gallbladder wall thickening was absent in BA but present in 46/186 non-BA infants.

Conclusions:

  • The gallbladder ghost triad is a highly specific and sensitive sonographic marker for extrahepatic biliary atresia.
  • Close follow-up is recommended for indeterminate cases to ensure accurate diagnosis and treatment.