Cholestatic syndromes in infancy and childhood

Of 33 children with various cholestatic syndromes who were studies with sonography, 19 also had 131I rose bengal scintigraphy, and 12 also had 99mTc sulfur colloid scintigraphy. Patients were categorized into intra- or extrahepatic etiologies for their cholestasis. Of 19 children in the extrahepatic category, 17 had abnormal sonographic studies; two with biliary atresia appeared normal. All 14 patients in the intrahepatic category had normal sonographic studies. Rose bengal was most useful when demonstrating biliary patency. Some cases of biliary atresia with normal sonography and lack of rose bengal excretion into the intestinal tract could not be separated from cases of neonatal hepatitis using a similar combination of studies. Radiocolloid studies were less valuable than other examinations except when demonstrating diffuse hepatic reticuloendothelial dysfunction as found in two cases of congenital syphilitic hepatitis.