Findings in percutaneous trans-hepatic cholecysto-cholangiography in neonates and infants presenting with conjugated hyperbilirubinemia: emphasis on differential diagnosis and cholangiographic patterns

• Published in: BMC pediatrics Vol. 23; no. 1; p. 22
• Main Authors: Parra, Dimitri A, Peters, Shannon E, Kohli, Ruhail, Chamlati, Racha, Connolly, Bairbre L, Wolinska, Justyna M, Ng, Vicky L, Temple, Michael J, John, Philip R, Kamath, Binita M, Ling, Simon C, Fecteau, Annie, Amirabadi, Afsaneh, Amaral, Joao G
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 14.01.2023; BioMed Central; BMC
• Subjects: Biliary atresia; Biliary Atresia - diagnosis; Biliary Atresia - diagnostic imaging; Cholangiography - methods; Cholestasis - diagnostic imaging; Cholestasis - etiology; Complications and side effects; Conjugated hyperbilirubinemia, Alagille’s syndrome; Diagnosis; Diagnosis, Differential; Female; Gallbladder - diagnostic imaging; Humans; Hyperbilirubinemia - etiology; Infant; Infant, Newborn; Male; Methods; Neonatal jaundice; Pediatric cholangiography; Pediatric research; PTCC; Retrospective Studies; Risk factors; Canada; PTCC; Biliary atresia; Pediatric cholangiography; Conjugated hyperbilirubinemia, Alagille’s syndrome
• ISSN: 1471-2431; 1471-2431
• DOI: 10.1186/s12887-022-03816-y

Biliary atresia (BA) is one of the causes of conjugated hyperbilirubinemia in infants which if untreated leads to end-stage liver disease and death. Percutaneous Trans-hepatic Cholecysto-Cholangiography (PTCC) is a minimally invasive study which can be utilized in the diagnostic work-up of these patients. This study's purpose is to describe the experience with PTCC in neonates, the imaging findings encountered, and the abnormal patterns which warrant further investigation. A 16-year single-center retrospective study of patients with persistent neonatal cholestasis (suspected BA) undergoing PTCC. Patient demographics, laboratory values, PTCC images, pathology and surgical reports were reviewed. 73 patients underwent PTCC (68% male, mean age 8.7 weeks, mean weight 4.0 Kg). The majority of studies were normal (55%). Abnormal patterns were identified in 33 cases, 79% were diagnosed with BA and 12% with Alagille syndrome. Non-opacification of the common hepatic duct with a narrowed common bile duct (42%) and isolated small gallbladder (38%) were the most common patterns in BA. PTCC is a minimally invasive study in the diagnostic work-up of infants presenting with conjugated hyperbilirubinemia (suspected BA). Further invasive investigations or surgery can be avoided when results are normal.