Intrahepatic biliary stones in children

Area of Science:

• Pediatric Radiology
• Hepatology
• Gastroenterology

Background:

• Intrahepatic biliary stones are uncommon in non-Oriental populations, particularly in children.
• Previous literature has primarily described these stones in the context of Oriental cholangitis.
• The radiological presentation in non-Oriental pediatric patients remains poorly characterized.

Purpose of the Study:

• To describe the variable radiological appearances of intrahepatic biliary stones in seven non-Oriental children.
• To evaluate the utility of different imaging modalities in diagnosing these stones.
• To increase awareness among clinicians and radiologists regarding this rare condition in pediatric patients.

Main Methods:

• Retrospective review of seven non-Oriental pediatric patients with intrahepatic biliary stones.
• Imaging studies included sonography (n=7), computed tomography (CT) (n=4), and percutaneous transhepatic cholangiography (PTC) (n=4).
• Clinical data including underlying conditions such as extrahepatic biliary atresia, liver transplantation, cystic fibrosis, and immunodeficiency syndrome were analyzed.

Main Results:

• All sonograms demonstrated abnormal echogenic foci within the liver, with or without biliary dilatation.
• CT confirmed biliary tract dilatation but identified calculi in only one patient.
• PTC was crucial in diagnosing sclerosing cholangitis in an immunodeficient patient.

Conclusions:

• Intrahepatic biliary stones in non-Oriental children can present with variable imaging features.
• Sonography is sensitive for detecting echogenic foci, while CT and PTC play complementary roles in diagnosis and characterizing associated conditions.
• This condition should be considered in the differential diagnosis of pediatric liver diseases presenting with abnormal biliary findings.