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Published on: March 25, 2022
Angiographic findings in biliary atresia
Renan Uflacker1, Danièle M Pariente
1Interventional Radiology, Medical University of South Carolina, Charleston, USA. uflacker@musc.edu
Insights
Angiography reveals characteristic vascular "tuft-like" blush in the hepatic arterial circulation of patients with biliary atresia (BA). This finding, along with arterial irregularities, may serve as a diagnostic marker for BA.
Area of Science:
- Radiology
- Pediatric Gastroenterology
- Vascular Imaging
Background:
- Biliary atresia (BA) is a serious neonatal liver disease.
- Angiography is used in the work-up and management of BA.
- Understanding the vascular changes in BA is crucial for diagnosis and treatment.
Purpose of the Study:
- To describe the angiographic findings in patients with biliary atresia.
- To identify characteristic angiographic features of BA.
- To evaluate the diagnostic utility of these findings.
Main Methods:
- Hepatic and mesenteric angiography were performed on 46 patients with histologically confirmed BA.
- Angiographic findings were analyzed, focusing on hepatic artery morphology and flow patterns.
- Microfil injection was used in one case to visualize vascular proliferation.
Main Results:
- All patients showed an enlarged hepatic artery with irregularities in peripheral branches (encasement, strictures, dilatation, occlusion).
- A vascular "tuft-like" blush surrounding these arterial segments was observed in 40 patients.
- Portal vein was patent in 43 patients, with variable flow direction and frequent gastroesophageal varices.
Conclusions:
- Perivascular arterial tufts in the hepatic arterial circulation are a common angiographic finding in BA.
- These "tuft-like" vascular proliferations may be a characteristic diagnostic feature of biliary atresia.
- Angiography provides valuable insights into the vascular abnormalities associated with BA.
Abstract:
We present the angiographic findings of 46 patients with biliary atresia (BA). There were 25 males and 21 females, with a mean age of 22.5 months (range - 1.5 to 141 months). Hepatic and mesenteric angiography were obtained as part of a liver transplantation work-up or as part of the treatment of clinical events. All patients had a histological diagnosis of BA. The portal vein was patent in 43 patients, with a mean size of 4.1 mm, using the arterial catheter as comparison. Portal hepatopetal flow was observed in 20 patient and hepatofugal flow was observed in 21 patients. Presence of gastroesophageal varices was observed in 41 patients. The hepatic artery was enlarged in all patients. In all 46 patients studied, the intrahepatic peripheral hepatic artery branches presented with irregularities in contour, including encasement, strictures, dilatation and angulation, and images suggestive of peripheral occlusion. Angiographic vascular "tuft-like" blush surrounding the irregular or occluded peripheral arterial segments was observed in 40 patients. The injection of Microfil in one case showed a marked vascular proliferation within the portal tract, apparently derived from arterial and portal connections, filling the entire portal space. We conclude that the presence of angiographically demonstrable perivascular arterial tufts in the periphery of the hepatic arterial circulation is a common finding in cases of BA, and may be a characteristic diagnostic angiographic finding.