neonatal hepatitis radiology

Inspissated bile syndrome in a 2-month-old infant with jaundice and dehydration. This type is associated with autosomal recessive polycystic kidney disease and is called Caroli syndrome when accompanied by congenital hepatic fibrosis. In this study, liver biopsy is reported as the most reliable method to differentiate INH from BA. Majid M, Reba RC, Altman RP: Hepatobilitary scintigraphy with 131 Tc-PIPIDA in the evaluation of neonatal jaundice.Pediatrics 67: 140, 1981. Simple cysts are unilocular and smooth walled, and in an otherwise normal-appearing liver, these are usually asymptomatic and can be observed (73). Recanalized ductus venosus in a 7-year-old girl with end-stage liver disease. Preterm infants are probably more susceptible due to their relatively immunocompromised state (95). Algorithm for the differentiation of hepatitis, biliary atresia, and choledochal cyst in the neonate. MR cholangiography may also be useful in preoperative assessment of these lesions (,45). A = aorta, HV = hepatic vein, pv = portal vein. Metastatic disease is seen with congenital forms of certain malignancies such as neuroblastoma and leukemia and usually manifests with multiple masses or diffusely infiltrative disease leading to hepatomegaly (67) (Fig 13). Viewer. Serum AFP levels are normal or only mildly elevated, which helps differentiate mesenchymal hamartoma from hepatoblastoma (52,63). (b) Duplex Doppler US image shows the hepatofugal flow via the recanalized ductus venosus (arrow) into the inferior vena cava (IVC). Its US appearance depends more on the severity and stage of disease than on the causative agent. Cholelithiasis in neonates and young infants is usually secondary to predisposing conditions such as obstructive congenital anomalies of the biliary tract (,29); a history of total parenteral nutrition, furosemide treatment, or phototherapy; dehydration; infection; hemolytic anemias; and short-gut syndrome (,51,,62,,64–,66). Figure 13. HV = hepatic vein. Figure 31a. Sagittal sonogram shows a coarse liver texture and dilated anechoic tubular structures (arrows) that widen the lesser sac, a finding that, before the era of duplex color Doppler US, was presumed to represent varices. Figure 15. The PRETEXT system is based on cross-sectional imaging assessment of the extent of tumor involvement of four main sections of the liver. (b) Duplex Doppler US image shows the hepatofugal flow via the recanalized ductus venosus (arrow) into the inferior vena cava (IVC).Download as PowerPointOpen in Image Potential etiologies include vessel perforation by a UVC, sepsis, hypoxia, trauma, and coagulopathy (98–100). The gallbladder distention may be due to thickened bile, which causes transient obstruction, but most commonly results from biliary stasis secondary to dehydration or prolonged fasting (,73,,74). Cholangiography.—Cholangiography is indicated when the imaging and pathologic findings suggest the diagnosis of biliary atresia. (a) Transverse scan of the pancreas (P) shows a round, solid heterogeneous mass (arrows) in the region of the pancreatic head. Hepatoblastoma in a 7-month-old boy with an abdominal mass. The mass, a choledochal cyst (CC), tapers cranially. (b) Transverse sonogram of the liver demonstrates dilated intrahepatic ducts (arrows) and coarse liver echotexture thought to be due to cholestasis. Choledochal cyst (type IA) in a 6-year-old girl with jaundice and clinical evidence of pancreatitis. Figure 7: Inspissated bile syndrome. Transverse hepatic sonogram demonstrates coarse liver texture and a slightly hypoechoic, rounded mass posteromedially in the right lobe (calipers). 2014, International Journal of Pediatric Otorhinolaryngology, Vol. Patients present with palpable mass and anorexia, and complications include rupture, hemorrhage, and metastases. Low-power photomicrograph (hematoxylin-eosin stain) demonstrates lobular disarray, giant cell transformation, and mononuclear lobular infiltrate.Download as PowerPointOpen in Image Vascular invasion and hypoenhancement of the tumor relative to the liver parenchyma are useful features in distinguishing hepatoblastoma from hemangioma (64,68,69) (Fig 12). Stage IV-S neuroblastoma may manifest with diffuse heterogeneous involvement of the entire liver (,54,,56), along with a primary adrenal mass, lymphadenopathy, and bone marrow involvement but no skeletal metastases (,Fig 22). Figure 24. Sagittal sonogram of the gallbladder shows multiple conglomerations of tumefactive sludge (sludge balls) (arrows). 2, Journal of Pediatric Surgery, Vol. Choledochal cyst (type IC) with biliary atresia in a female neonate with jaundice. Figure 22. Change in gallbladder size after a milk feeding suggests patency of the common hepatic and common bile ducts and is seen only with neonatal hepatitis (,23). Jaundice in infants and children may also be due to cirrhosis, benign strictures, and neoplastic processes. Figure 12. Viewer. (a) Duplex Doppler US image demonstrates hepatopedal flow in the portal vein (arrowhead) with recanalization of the ductus venosus (arrow). 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. (a) Axial T2-weighted MR image in a 6-month-old female infant with hepatomegaly demonstrates a large, heterogeneous mass replacing the left hepatic lobe. After reading the article and taking the test, the reader will be able to: ■ Identify causes and treatment of neonatal cholestasis, ■ Recognize US findings of biliary atresia, ■ Distinguish between common neonatal liver masses based on imaging and clinical features, ■ Recognize Doppler US findings of congenital hepatic shunts, ■ Recognize hepatic complications of umbilical vein catheterization. Cholelithiasis. Figure 15b: Arterioportal fistula. Other causes include infection, especially congenital cytomegalovirus, cholestasis associated with total parenteral nutrition (TPN), metabolic disorders, α-1 antitrypsin deficiency, and genetic causes including Alagille syndrome and progressive familial intrahepatic cholestasis (PFIC) (12,13). 6, Gastroenterology Research and Practice, Vol. Caroli disease in a 7-year-old girl with jaundice and intermittent right upper quadrant pain. This condition is thought to be related to an abnormal insertion of the common bile duct into the pancreatic duct, which causes reflux of pancreatic enzymes into the pancreatic duct. Hypointense septations may be present in mixed-type tumors (68). RK = right kidney.Download as PowerPointOpen in Image Transverse US scan in a 4-day-old premature female infant with a UVC demonstrates an echogenic thrombus (white arrow) adherent to the catheter (arrowhead), within the left portal vein (black arrow) at the umbilicoportal confluence. Hepatobiliary scintigraphy is often indicated to distinguish between neonatal hepatitis and biliary atresia (,2,,14,,20). Choledochal cysts are classified on the basis of their location according to the Todani system (45). PSS is further subcategorized based on the presence or absence of the portal trunk, anatomy of shunt origin and termination, type of communication (side-to-side or end-to-side), and whether there are single or multiple communications (65,79–81). Color Doppler US scan in a 2-day-old female infant obtained for hyperbilirubinemia incidentally shows a thrombosed ductus venosus (arrow) as an avascular hypoechoic structure extending to the left hepatic vein (HV). This finding was confirmed with duplex Doppler US.Download as PowerPointOpen in Image The initial US images were retrospectively reviewed for gallbladder (GB) morphology with systemic classification, GB length and luminal area, presence of triangular-cord (TC) sign and … A = aorta, HV = hepatic vein, pv = portal vein. (b)Transverse sonogram of the pancreas (P) and gallbladder (GB) demonstrates an obstructing stone (arrow) in the distal most part of the common bile duct.Download as PowerPointOpen in Image 41, No. Viewer. Viewer. Liver US should be performed with the patient fasting to minimize the amount of bowel gas and to allow full distention of the gallbladder; 3–4 hours of fasting is sufficient for young infants. Recanalized ductus venosus in a 7-year-old girl with end-stage liver disease. 19, No. (c) Transverse US scan demonstrates heterogeneous echotexture of the mass (arrowheads), which contains multiple echogenic foci consistent with calcifications. Final diagnoses included extrahepatic biliary atresia, neonatal hepatitis, cystic fibrosis, metabolic liver disease, alpha 1-antitrypsin deficiency, bile duct stenosis, Alagille The gallbladder (GB) is abnormally elongated in appearance, with a length of 24 mm and width of 3 mm (length-to-width ratio = 8). Laboratory work-up may include liver function tests, testing for hepatitis B antigen, TORCH (toxoplasmosis, other [syphilis, hepatitis, zoster], rubella, cytomegalovirus, and herpes simplex [maternal infections]) titers, work-up for sepsis (blood, urine, cerebrospinal fluid), metabolic screening (α1-antitrypsin phenotype testing), and sweat test. 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. Neonatal hepatitis radiology discussion including radiology cases. In cases of severe hepatocellular dysfunction, the gallbladder may be reduced in size because of the decreased volume of bile. Hemangioendothelioma in a 9-month-old boy with hepatomegaly. Figure 14b. 51, No. (c) Transverse US scan demonstrates heterogeneous echotexture of the mass (arrowheads), which contains multiple echogenic foci consistent with calcifications. ■ Infantile hepatic hemangiomas (IHHs) differ from congenital hepatic hemangiomas (CHHs) in that IHHs appear after birth, proliferate during the first few months of life, and are treated with propranolol, whereas CHHs tend to be fully formed at the time of birth and are not responsive to propranolol. PFIC3 usually manifests in late infancy through adulthood, with impaired biliary phospholipid secretion, resulting in elevated serum GGT. Figure 28a. Ultimately, liver biopsy and genetic testing are needed for diagnosis. From the Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210 St, Bronx, NY 10467. 2, © 2021 Radiological Society of North America, SCIENTIFIC EXHIBIT - Continuing Medical Education, https://doi.org/10.1148/radiographics.20.1.g00ja25173, Open in Image The major risk factor for neonatal PVT is UVC placement, particularly when the UVC is in place for extended periods of time or when it is used for transfusions, although some critically ill neonates without UVCs may also develop PVT (90–92). The normal pediatric pancreas is isoechoic or minimally hyperechoic compared with the liver. Acute cholecystitis is uncommon in infants and children. Neonates and umbilical venous catheters: normal appearance, anomalous positions, complications, and potential aid to diagnosis, Prognostic value of abdominal sonography in necrotizing enterocolitis of premature infants born before 33 weeks gestational age, Does umbilical vein catheterization lead to portal venous thrombosis? Sagittal sonogram of the liver shows brightly echoic peripheral portal venous vasculature and moderate hepatomegaly. Hepatofugal flow in a premature male infant with jaundice and cirrhosis following prolonged total parenteral nutrition. Choledochal cyst (type IA) in a 6-year-old girl with jaundice and clinical evidence of pancreatitis. Neonatal hemochromatosis due to GALD has been shown to have good response to intravenous immunoglobulin and exchange transfusion; however, some patients will require liver transplantation (39). Although hepatic malignancies are the most common gastrointestinal malignancy in children, they account for less than 2% of all pediatric malignancies. Noninvoluting congenital hemangioma does not regress but may grow in proportion to the child (54). Figure 30. Differential diagnosis includes mesenchymal hamartoma and abscess if the cyst is complex or enlarging, and intrahepatic choledochal cyst if the cyst is associated with biliary ductal dilatation. The RSNA designates this journal-based SA-CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Figure 12. See print version. 9, No. Rhabdomyosarcoma of the common bile duct in a 7-year-old boy with jaundice, hepatomegaly, and itching. Figure 9b. 3, Journal of Evolution of Medical and Dental Sciences, Vol. In older children, causes of biliary stones include sickle cell disease (,67), cystic fibrosis (,68), malabsorption, total parenteral nutrition, Crohn disease, intestinal resection, hemolytic anemia, and choledochal cyst (,69–,71). The surrounding hepatic echotexture is coarse. (b)Transverse sonogram of the pancreas (P) and gallbladder (GB) demonstrates an obstructing stone (arrow) in the distal most part of the common bile duct.Download as PowerPointOpen in Image (c) On another color Doppler image, intrahepatic ductal dilatation (arrows) is evident. Drawing illustrates the typical collateral channels in cirrhosis and portal hypertension. Hepatic hemangiomas are the most common benign hepatic tumor of infancy and are considered true vascular neoplasms. Cholelithiasis. Hepatocellular carcinoma has variable echogenicity, either hypo-, iso-, or hyperechoic relative to the surrounding liver parenchyma (,Fig 18). (a) Transverse sonogram shows a minimally enlarged pancreas (P) and a 4-cm anechoic cyst (C) in the region of the pancreatic head. The hepatic artery (HA) is markedly enlarged, and multiple dilated hepatic veins (arrowheads) are also seen. Preduodenal portal vein and malrotation: what causes the obstruction? Figure 25b. Viewer, Percutaneous US-guided Cholecystocholangiography with Microbubbles for Assessment of Infants with US Findings Equivocal for Biliary Atresia and Gallbladder Longer than 1.5 cm: A Pilot Study, Vascular Anomalies of the Pediatric Liver, Risk Estimation for Biliary Atresia in Patients with Neonatal Cholestasis: Development and Validation of a Risk Score, A Comprehensive Approach to Hepatic Vascular Disease, Pediatric Liver Transplant: Techniques and Complications, Neonatal Jaundice: A Multimodality Imaging Approach, Congenital and Developmental Diseases of the Biliary System: Current Update on Pathology and Imaging Findings, Vascular Anomalies of the Pediatric Native Liver. Figure 7. In infants with poor biliary excretion and resultant underfilling of the gallbladder, sonographic differentiation between neonatal hepatitis and biliary atresia may be difficult, unless the common bile duct is clearly seen and amenable to accurate measurement. 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