J Korean Radiol Soc.  2006 Aug;55(2):177-182. 10.3348/jkrs.2006.55.2.177.

Ultrasound-guided Percutaneous Cholecysto-Cholangiography for the Exclusion of Biliary Atresia in Infants

• Shin KM
• Ryeom HK
• Choe BH
• Kim KC
• Kim JY
• Lee JM
• Kim HJ
• Lee HJ

• KMID: 2103817
• DOI: http://doi.org/10.3348/jkrs.2006.55.2.177

Abstract

PURPOSE
The aim of this study is to determine the feasibility and effectiveness of performing an ultrasound-guided percutaneous cholecysto-cholangiogram (PCC) for excluding biliary atresia as the cause of neonatal jaundice.
MATERIALS AND METHODS
Between Oct. 2003 and Feb. 2005, six ultrasound-guided PCC procedures were performed to five jaundiced infants (4 females and 1 male; mean age: 60 days old) for whom possibility of biliary atresia could not be ruled out by the DISIDA scan as the cause of their neonatal jaundice. Gallbladder puncture was performed under ultrasound guidance with a 23-gauge needle. Contrast material injection during fluoroscopic examination was performed after dilatation of the gallbladder lumen with normal saline under ultrasound guidance. The criteria used for excluding biliary atresia were complete visualization of the extrahepatic biliary trees and/or contrast excretion into the duodenum. The complications and final diagnosis was assessed according to the clinical and laboratory findings.
RESULTS
The procedures were successful in all the patients without any complication. Biliary atresia could be ruled out in all the patients. The final diagnosis was neonatal cytomegalovirus hepatitis in two patients, total parenteral nutrition-associated cholestasis in two patients, and combined cytomegalovirus hepatitis and total parenteral nutrition-associated cholestasis in one patient.
CONCLUSION
Ultrasound-guided PCC is a feasible and effective method for the early definitive exclusion of biliary atresia as the cause of neonatal jaundice. By the technique of injecting normal saline before contrast injection, PCC can be done even in a totally collapsed or very small gallbladder.

Keyword

Bile duct, US; Infants; Gastrointestinal tract; Cholecystography; Cholangiography

MeSH Terms

Biliary Atresia*
Cholangiography
Cholecystography
Cholestasis
Cytomegalovirus
Diagnosis
Dilatation
Duodenum
Female
Gallbladder
Gastrointestinal Tract
Hepatitis
Humans
Infant*
Infant, Newborn
Jaundice, Neonatal
Male
Needles
Punctures
Ultrasonography