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Ultrasonography is useful in differentiating between cystic biliary atresia and choledochal cyst

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Abstract

Purpose

With the advent of ultrasonography (US), perinatal diagnosis of biliary cystic malformation (BCM) has become more prevalent. BCM includes cystic biliary atresia (CBA) and choledochal cyst (CC). Both share similar ultrasonographic features and clinical manifestations, and yet the postnatal management is very different. This study was to assess whether CBA can be distinguished from CC by US.

Methods

We retrospectively studied the clinical data of 98 BCM patients aged less than 130 days between January 2013 and November 2015. The patients were divided into the CBA group and the CC group based on intraoperative cholangiography. The ultrasonographic features in each group were then analyzed.

Results

Thirty-one children had CBA (type I: 24, type III: 7) and 67 children had CC (all: type I). The cyst volume did not show a significant change in the CBA group while the cyst volume increased postnatally in the CC group. Preoperative cyst volume can be used as a sensitive indicator to distinguish choledochal cyst from cystic biliary atresia. Gallbladder size in the two groups differed significantly (P = 0.034); 23 of 31 patients in the CBA group had atrophic gallbladder, whereas none of the patients in the CC group had atrophic gallbladder (P < 0.001). The triangular cord sign was detected in ten patients in the CBA group and in none of the patients in the CC group (P < 0.001).

Conclusion

Serial prenatal and postnatal ultrasonographic studies may help differentiate CBA from CC in the majority of BCM, facilitating prenatal counseling and postnatal management.

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Funding

The funding was received by the Public Welfare Research Special Fund of the National Health and Family Planning of China (Grant no. 201402007).

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Authors and Affiliations

  1. Department of Neonatal Surgery, Xian Childrens Hospital, Xian, Shaanxi, China

    Pu Yu & Yong Kang Pan

  2. Department of General Surgery, Capital Institute of Pediatrics, Beijing, China

    Ning Dong & Long Li

Authors
  1. Pu Yu
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  2. Ning Dong
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  3. Yong Kang Pan
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  4. Long Li
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Corresponding author

Correspondence to Long Li.

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The authors declare that they have no conflicts of interest.

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This article does not contain any studies with animals performed by any of the authors.

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This study was approved by the Capital Institute of Pediatrics hospital’s ethical board (SHERLL2013064).

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The individual written informed consent was waived because of the retrospective design.

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Yu, P., Dong, N., Pan, Y.K. et al. Ultrasonography is useful in differentiating between cystic biliary atresia and choledochal cyst. Pediatr Surg Int 37, 731–736 (2021). https://doi.org/10.1007/s00383-021-04886-2

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