Kosuga Masahiko, Fujii Yoshimitsu, Doi Takashi, Kaneko Kazunari, Breugelmans Raoul
Department of Pediatrics, Kansai Medical University, 2-5-1 Shin-machi, Hirakata 573-1010, Osaka, Japan.
Department of Pediatric Surgery, Kansai Medical University, 2-5-1 Shin-machi, Hirakata 573-1010, Osaka, Japan.
Pediatr Rep. 2023 Sep 6;15(3):541-547. doi: 10.3390/pediatric15030049.
Ultrasonography is an essential part of the diagnostic process of biliary atresia (BA). The characteristic findings of BA include a hilar hyperechoic zone, the triangular cord sign (TCS), an absence of gallbladder contraction after feeding, and gallbladder atrophy. However, approximately 10% of patients with BA have a normal gallbladder. We herein present two cases of BA with normal morphology of the gallbladder as shown by ultrasonography. In the first case, the patient was positive for the TCS, negative for gallbladder atrophy, and positive for contraction of the gallbladder after feeding; the final diagnosis was hilar obstructive BA complicated by pancreaticobiliary maljunction. In the second case, the patient was positive for the TCS, negative for gallbladder atrophy, and negative for contraction of the gallbladder after feeding; the patient also had common bile duct obstruction and stenosis of the hepatic duct in the hilar region. Based on these two cases, we conclude that gallbladder findings are not diagnostic for BA because in some types, the gallbladder may be normal in morphology and even have the capacity for contraction after feeding.
超声检查是胆道闭锁（BA）诊断过程的重要组成部分。BA的特征性表现包括肝门高回声区、三角索征（TCS）、喂食后胆囊无收缩以及胆囊萎缩。然而，约10%的BA患者胆囊正常。我们在此报告两例经超声检查显示胆囊形态正常的BA病例。第一例患者TCS阳性，胆囊无萎缩，喂食后胆囊收缩阳性；最终诊断为肝门部梗阻性BA合并胰胆管合流异常。第二例患者TCS阳性，胆囊无萎缩，喂食后胆囊收缩阴性；该患者还存在胆总管梗阻及肝门区肝管狭窄。基于这两例病例，我们得出结论，胆囊表现不能作为BA的诊断依据，因为在某些类型中，胆囊形态可能正常，甚至喂食后仍有收缩能力。
