Tan Kendrick Anne Poh Ann, Phua Kong Boo, Ooi Boo Chye, Tan Carolyn Eng Looi
Department of Diagnostic Imaging, Kandang Kerbau Women's and Children's Hospital, 100 Bukit Timah Road, 229899, Singapore.
Pediatr Radiol. 2003 May;33(5):311-5. doi: 10.1007/s00247-003-0867-z. Epub 2003 Mar 6.
To describe the gallbladder ghost triad and evaluate its usefulness in the sonographic diagnosis of extrahepatic biliary atresia (BA).
From October 1997 to February 2002, 217 fasted infants with cholestatic jaundice aged 2-12 weeks were examined sonographically. We defined the gallbladder ghost triad as gallbladder length <1.9 cm, lack of smooth/complete echogenic mucosal lining with an indistinct wall and irregular/lobular contour, and used it as a criteria for BA. Gallbladder wall thickness, triangular cord, diffuse periportal echogenicity and hepatic artery calibre were also recorded. Diagnosis of BA was confirmed surgically and histologically.
Thirty of 31 babies with BA demonstrated the gallbladder ghost triad. No false-positives were recorded. The 31st BA baby showed a normal gallbladder at 6 weeks, but developed the ghost triad at 8 weeks. Gallbladder wall thickening was seen in 46/186 non-BA babies, but not in BA. Triangular cord was observed in 24/31 babies. Twenty-two of 186 non-BA babies and 5/31 BA babies showed diffuse periportal echogenicity. The hepatic artery appeared more prominent in BA. All 31 babies diagnosed sonographically as BA had surgery. Three non-BA babies had "negative" laparotomies showing hypoplastic bile ducts.
The gallbladder ghost triad is a very accurate sign of BA. Indeterminate cases require close follow-up.
描述胆囊“幽灵三联征”，并评估其在肝外胆道闭锁（BA）超声诊断中的应用价值。
1997年10月至2002年2月，对217例年龄在2至12周、空腹的胆汁淤积性黄疸婴儿进行超声检查。我们将胆囊“幽灵三联征”定义为胆囊长度<1.9 cm、缺乏光滑/完整的高回声黏膜内衬且壁不清晰、轮廓不规则/呈分叶状，并将其作为BA的诊断标准。同时记录胆囊壁厚度、三角索、肝门周围弥漫性回声增强以及肝动脉内径。BA的诊断通过手术及组织学检查得以证实。
31例BA患儿中有30例表现出胆囊“幽灵三联征”。未记录到假阳性病例。第31例BA患儿在6周时胆囊正常，但在8周时出现了“幽灵三联征”。186例非BA患儿中有46例出现胆囊壁增厚，而BA患儿中未出现。31例患儿中有24例观察到三角索。186例非BA患儿中有22例以及31例BA患儿中有5例出现肝门周围弥漫性回声增强。BA患儿的肝动脉显得更为突出。所有31例超声诊断为BA的患儿均接受了手术。3例非BA患儿进行了“阴性”剖腹探查，显示胆管发育不良。
胆囊“幽灵三联征”是BA的一个非常准确的征象。不明确的病例需要密切随访。
