Document Detail

Making the diagnosis of biliary atresia using the triangular cord sign and gallbladder length.
MedLine Citation:
PMID:  10663514     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: To evaluate the accuracy and utility of the triangular cord sign and gallbladder length in diagnosing biliary atresia by sonography. MATERIALS AND METHODS: Sixty fasted infants with cholestatic jaundice aged 2-12 weeks were examined sonographically using a 5-10 MHz linear array transducer, focusing on the triangular cord sign (as described by Choi et al. [1]), the gallbladder, and ducts. The triangular cord is defined as a triangular or tubular echogenic density seen immediately cranial to the portal vein bifurcation; it represents the fibrotic remnant of the obliterated cord in biliary atresia. The findings were blinded to blood chemistry, (99 m)Tc-DISIDA hepatobiliary scintigraphy, and liver biopsy. Diagnosis of biliary atresia was confirmed at surgery and histology. Non-biliary atresia infants resolved medically. Comparative charges of the various investigations was made. RESULTS:++ Twelve infants had biliary atresia, and ten demonstrated a definite triangular cord. The two false-negatives had small or nonvisualized gallbladders. No false-positives were recorded. Gallbladder length ranged from 0-1.45 cm with a mean of 0. 52 cm in biliary atresia compared to a mean of 2.39 cm in nonbiliary atresia infants. (99 m)Tc-DISIDA hepatobiliary scintigraphy showed no excretion (false-positive) in 23 % of nonbiliary atresia cases. Scintigraphy and liver biopsy charges were 2 and 6 times that of sonography, respectively. CONCLUSION: The triangular cord sign and gallbladder length together are noninvasive, inexpensive, and very useful markers for biliary atresia.
A P Tan Kendrick; K B Phua; B C Ooi; R Subramaniam; C E Tan; A S Goh
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatric radiology     Volume:  30     ISSN:  0301-0449     ISO Abbreviation:  Pediatr Radiol     Publication Date:  2000 Feb 
Date Detail:
Created Date:  2000-06-01     Completed Date:  2000-06-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0365332     Medline TA:  Pediatr Radiol     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  69-73     Citation Subset:  IM    
Department of Diagnostic Imaging, Kandang Kerbau Women's and Children's Hospital, 100 Bukit Timah Road, Singapore.
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MeSH Terms
Bile Ducts, Extrahepatic / abnormalities*,  ultrasonography
Biliary Atresia / complications,  diagnosis,  ultrasonography*
Cholestasis / etiology
Diagnosis, Differential
Gallbladder / abnormalities*,  ultrasonography
Infant, Newborn
Jaundice, Neonatal / etiology
Prospective Studies
Sensitivity and Specificity

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