HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gubernick, J. A. Articles by Kessler, A. Search for Related Content PubMed PubMed Citation Articles by Gubernick, J. A. Articles by Kessler, A. Related Collections Pediatric Radiology Ultrasound Gastrointestinal Radiology

US Approach to Jaundice in Infants and Children¹

¹ From the Department of Radiology, Albert Einstein Medical Center, 5501 Old York Rd, Philadelphia, PA 19141-3098. Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received April 27, 1999; revisions requested June 22 and received August 17; accepted September 22. Address reprint requests to J.A.G.

High-resolution real-time ultrasonography (US) serves as an important tool for differentiation of obstructive and nonobstructive causes of jaundice in infants and children, independent of liver function. Unconjugated hyperbilirubinemia occurs in approximately 60% of normal term infants and in 80% of preterm infants. Persistence of neonatal jaundice beyond 2 weeks of age demands US evaluation to differentiate between the three most common causes: hepatitis, biliary atresia, and choledochal cyst. In all three conditions, the hepatic echotexture is diffusely coarse and hyperechoic, but this appearance may be seen in a variety of hepatic inflammatory, obstructive, and metabolic processes. Thus, hepatic scintigraphy and at times percutaneous liver biopsy are necessary to narrow the differential diagnosis and to identify patients who require more invasive techniques (eg, intraoperative cholangiography). US is useful for demonstrating inspissated bile and biliary duct stones. In infants, stones are usually secondary to obstructive congenital anomalies of the biliary tract, total parenteral nutrition, furosemide treatment, phototherapy, dehydration, infection, hemolytic anemia, and short-gut syndrome, whereas in older children, stones are usually associated with sickle cell disease, bowel resection, hemolytic anemia, and choledochal cyst. Jaundice in infants and children may also be due to cirrhosis, benign strictures, and neoplastic processes.

Index Terms: Bile ducts, abnormalities, 76.288 • Children, gastrointestinal tract • Hepatitis, 761.291 • Infants, gastrointestinal tract • Jaundice, 76.288, 761.291, 766.1492 • Bile ducts, cysts, 766.1492 • Liver, diseases, 76.28, 761.291 • Liver neoplasms, in infants and children, 761.30

This article has been cited by other articles:

				J Cyriac, M Rigby, and A Baker Changing colours Arch. Dis. Child. Ed. Pract., October 1, 2008; 93(5): 145 - 150. [Full Text] [PDF]

				H E Woodley Imaging of the jaundiced child Imaging, September 1, 2004; 16(4): 301 - 313. [Abstract] [Full Text] [PDF]

				B. P. Wood Ultrasound Triangles and Biliary Atresia AAP Grand Rounds, February 1, 2004; 11(2): 19 - 19. [Full Text] [PDF]

				H.-J. Lee, S.-M. Lee, W.-H. Park, and S.-O. Choi Objective Criteria of Triangular Cord Sign in Biliary Atresia on US Scans Radiology, November 1, 2003; 229(2): 395 - 400. [Abstract] [Full Text] [PDF]

				M. S. Metcalfe, S. A. Wemyss-Holden, and G. J. Maddern Management Dilemmas With Choledochal Cysts Arch Surg, March 1, 2003; 138(3): 333 - 339. [Abstract] [Full Text] [PDF]