Diagnostic Evaluation of Infantile Cholestasis
Lumduan Wongsawasdi MD*, Nuthapong Ukarapol MD*, Pannee Visrutaratna MD**, Jesda Singhavejsakul MD***, Vinaisak Kattipattanapong MD***
Affiliation : * Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai ** Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai *** Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai
Objective : To evaluate diagnostic accuracy of some important clinical manifestations and different investiga-
tions in infantile cholestasis.
Material and Method: Infants diagnosed with prolong conjugated hyperbilirubinemia and admitted to Chiang
Mai University Hospital between Jan 1999 and Feb 2003. Demographic and clinical data were recorded.
Routine biochemical tests, and serology for TORCHS infections were carried out. An abdominal ultrasonog-
raphy, DISIDA scan and percutaneous/open liver biopsy were performed. Hyperechoic band at the level of
portal bifurcation, named triangular cord (TC) sign was blindly assessed on ultrasonography by the same
radiologist. The patients were diagnosed as BA if either operative findings of atretic common bile duct/
gallbladder or evidence of bile duct obstruction demonstrated by intraoperative cholangiography was noted.
Results : Sixty-one patients were diagnosed as BA (n = 31) and NH (n = 30) with an average age at diagnosis
of 88.6 and 63.1 days respectively. Concerning clinical presentations, only the presence of acholic stool was
significantly different between BA and NH (p = 0.006). The GGT level of greater than 500 IU/L was significantly
found in BA (p < 0.001). The acholic stool and GGT level more than 500IU/L were highly specific for BA at 100
and 96.6% respectively. In addition, the sensitivity and specificity of US-TC and DISIDA scan were 87.4, 100
and 89.7, 92.0% respectively. The accuracy for diagnosis of BA were highest by DISIDA scan (96.3) followed
by US-TC (86.9), GGT level of > 500 IU/L(81.0) and acholic stool(80.3) in order.
Conclusion : There was no single laboratory investigation that could precisely make a definite diagnosis of
BA. The acholic stool and GGT level of higher than 500 IU/L were highly specific for BA. The TC in ultrasound
is noninvasive and easily available tests when combined with acholic stool and the GGT level is suggested
plan of management.
Keywords : Cholestasis, Jaundice, Neonatal, Biliary atresia
