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Updated: Jan 17, 2026
A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
Published on: April 7, 2023
Point-of-Care Ultrasound Evaluation of Biliary Atresia in the Pediatric Emergency Department
James W Tsung1, Saranya Ramadurai2, Philip Sosa3
1Departments of Emergency Medicine and Pediatrics.
Insights
Persistent infant jaundice requires prompt evaluation. Point-of-care ultrasound (POCUS) can expedite diagnosis of biliary atresia, a critical liver condition in newborns, leading to faster treatment.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Imaging
- Surgical Pediatrics
Background:
- Persistent jaundice beyond two weeks necessitates investigation for neonatal cholestasis or hyperbilirubinemia.
- Biliary atresia, a leading cause of pediatric liver disease mortality, can be fatal within a year if untreated.
- Kasai hepatic portoenterostomy failure in biliary atresia is a primary indication for pediatric liver transplantation.
Purpose of the Study:
- To highlight the utility of point-of-care ultrasound (POCUS) in the early detection of biliary atresia.
- To demonstrate how POCUS can expedite the diagnostic process for suspected biliary atresia in neonates.
- To present a case where POCUS facilitated timely intervention for a critical liver condition.
Main Methods:
- Initial assessment of neonatal jaundice using point-of-care ultrasound (POCUS).
- Focused ultrasound examination for specific biliary atresia indicators: gallbladder absence and the triangular cord sign (TCS).
- Measurement of the echogenic anterior wall of the right portal vein (EARPV > 4 mm) as a diagnostic criterion.
- Confirmation of diagnosis through subsequent liver biopsy and surgical intervention.
Main Results:
- Point-of-care ultrasound identified key signs suggestive of biliary atresia.
- The use of POCUS in this case expedited the diagnostic timeline.
- Subsequent liver biopsy and surgery confirmed the POCUS findings and the diagnosis of biliary atresia.
Conclusions:
- Point-of-care ultrasound is a valuable tool for the rapid evaluation of suspected biliary atresia in newborns.
- Early POCUS can significantly expedite the diagnosis and management of biliary atresia, potentially improving outcomes.
- Integrating POCUS into neonatal jaundice protocols can streamline care pathways for critical liver diseases.
Abstract:
Persistent jaundice in a newborn infant past 2 weeks of age requires timely evaluation for cholestasis or unconjugated hyperbilirubinemia. Untreated biliary atresia may result in death within a year of age and is the most common cause of death in children with liver disease. It is also the most common indication for liver transplantation in children when Kasai hepatic portoenterostomy fails. Ultrasound is the primary initial imaging modality for suspected biliary atresia, primarily looking for absence of the gallbladder and the triangular cord sign, with a thickened echogenic anterior wall of the right portal vein (EARPV measuring >4 mm). We report a case in which point-of-care ultrasound was used to evaluate suspected biliary atresia and expedite care, with the diagnosis subsequently confirmed by liver biopsy and surgery.
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