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小儿阻塞性黄疸的影像学表现。

Imaging in Pediatric Obstructive Jaundice.

机构信息

Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.

出版信息

Indian J Pediatr. 2022 Sep;89(9):899-907. doi: 10.1007/s12098-022-04171-7. Epub 2022 Jun 2.

Abstract

Cholestatic jaundice characterized by elevated conjugated bilirubin can be due to multitude of factors in neonates and childhood. Extrahepatic biliary atresia (EHBA), choledochal cyst, neonatal hepatitis, cytomegalovirus (CMV), and biliary plug are some of the common causes in neonate and early infancy. Causes in late infancy and childhood comprises viral hepatitis, choledochal cyst, cholelithiasis, worm infestation, and biliary compression secondary to extrinsic causes (node, collection, tumor). Some serious disorders like biliary atresia must be considered with the emphasis on early diagnosis of treatable causes. In the modern era, with multiple diagnostic modalities available including high-resolution ultrasonography, magnetic resonance imaging (MRI), CT scan, and nuclear imaging [hepatobiliary iminodiacetic acid (HIDA) scan], rapid diagnosis can be made in many surgically treatable cases. The authors will discuss the imaging modality available with advantages, disadvantages, and common indications of each modality, and overview of obstructive jaundice discussing the wide spectrum of causes in neonates and late childhood. Combining available knowledge with careful and meticulous search can help narrow down the diagnosis and initiate prompt treatment.

摘要

胆汁淤积性黄疸的特征是结合胆红素升高,可由新生儿和儿童的多种因素引起。肝外胆道闭锁(EHBA)、胆总管囊肿、新生儿肝炎、巨细胞病毒(CMV)和胆管栓子是新生儿和婴儿早期的一些常见原因。婴儿晚期和儿童期的病因包括病毒性肝炎、胆总管囊肿、胆石症、寄生虫感染以及由外部原因(淋巴结、积聚、肿瘤)引起的胆管压迫。一些严重的疾病,如胆道闭锁,必须加以考虑,并强调对可治疗病因的早期诊断。在现代,由于有多种诊断方法可供选择,包括高分辨率超声、磁共振成像(MRI)、CT 扫描和核成像[肝胆酸(HIDA)扫描],许多可手术治疗的病例可以快速诊断。作者将讨论现有的成像方式,包括每种方式的优缺点和常见适应证,并概述梗阻性黄疸,讨论新生儿和儿童晚期广泛的病因。将现有知识与仔细、细致的搜索相结合,可以帮助缩小诊断范围并及时开始治疗。

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