[Jaundice in Young Children]

Abstract

Jaundice in children have various etiologies. Among them, physiological jaundice is a very common disease observed in more than half of full-term neonates. When jaundice persists or develops after 2 weeks of age, the total/direct bilirubin is measured in consideration of the possibility of cholestasis. In case of cholestasis, imaging studies differentiate biliary atresia and other disorders of the extrahepatic bile ducts. In this review, we briefly presented the major differential diseases of cholestasis in children and introduced diagnostic imaging techniques, including normal findings.

Fig. 1. Normal gallbladder.

A. Ultrasonographic images of normal gallbladders. B. The schematic drawing of normal gallbladders was adapted from reference (5).

Fig. 2. MR cholangiopancreatography.

A. In a 2-month-old body with cholestatic hepatitis, MR cholangiopancreatography shows normal gallbladder (arrow) and biliary tree. B. In a 1-month-old boy with biliary atresia, MR cholangiopancreatography shows small collapsed gallbladder (arrow) and nonvisible biliary tree.

Fig. 3. Hepatobiliary scan.

A. In a 2-month-old boy with hyperbilirubinemia, hepatobiliary scan shows normal gallbladder filling (arrows) and bowel clearance. B. No biliary excretion is seen even on the delayed image at 24 hours, indicating biliary atresia.

Fig. 4. Percutaneous cholecysto-cholangiography.

A. Normal opacification of the gallbladder and biliary tree is shown. Contrast passage into the bowel is noted (arrow). B. Biliary atresia is shown. The gallbladder is not fully distended, and the bile duct is not opacified. Contrast leakage (arrow) occurred with the forceful injection of the contrast media.

Fig. 5. Classification of cholestasis in infants.

ARC = arthrogryposis-renal dysfunction-cholestasis, NICCD = neonatal intrahepatic cholestasis caused by citrin deficiency, PFIC = progressive familial intrahepatic cholestasis, TPN = total parental nutrition, UTI = urinary tract infection

Fig. 6. Alagille syndrome is shown in the ultrasonographic images of a 2-month-old girl with cholestatic jaundice.

A. The gallbladder is small (< 1 cm), despite prolonged fasting. B. No echogenic thickening along the portal vein (arrow) is noted (negative triangular cord sign). The patient was diagnosed with Alagille syndrome with a JAG1 gene mutation.

Fig. 7. Bile plug syndrome.

A. The oblique sagittal view of the hepatic hilum reveals diffuse dilatation of the hilar and extrahepatic bile duct (arrow). Small sludge (arrowhead) is suspected in the distal bile duct. B, C. A pair of gray-scale and color Doppler images of the head portion of the pancreas show a hypoechoic bile plug blocking the intrapancreatic bile duct (arrow).