PEDIATRICS Vol. 108 No. 2 August 2001, pp. 416-420
Evaluation of the Triangular Cord Sign in the Diagnosis of Biliary Atresia
Received Jan 20, 2001; accepted Mar 22, 2001.
,,,
From the * Departments of Pediatrics and Radiology, Cairo
University Children's Hospital, Cairo, Egypt; Background. Infantile cholestasis
continues to represent a diagnostic challenge. It is very important to
diagnose surgically correctable disorders, such as biliary atresia, in
a timely manner to prevent progressive damage to the liver. It has been
recently suggested that the triangular cord (TC) sign is a simple and
useful tool in the diagnosis of biliary atresia.
Methods. We prospectively studied 65 infants presenting
with conjugated hyperbilirubinemia (age range: 32-161 days). All
patients underwent ultrasonographic examination with a 7.0-MHz
transducer (Acuson, Mountain View, CA). The TC was defined as a
triangular, or tubular, echogenic density seen immediately cranial to
the portal vein bifurcation.
Results. The TC sign was identified in 25 infants, and all
of them had histologic features suggestive of biliary atresia; the
diagnosis was confirmed at surgery by gross morphology of hepatobiliary system, and liver biopsy, with or without intraoperative cholangiogram. Among the 40 patients who did not have the TC sign, 6 had paucity of
the intrahepatic bile ducts. Three had alph-1-antitrypsin deficiency, and 31 had neonatal hepatitis. None of the 40 patients who did not have
the TC sign developed acholic stools. Seven patients with biliary
atresia were followed by ultrasonographic examination for 6 months
after the Kasai procedure. The TC sign disappeared in all patients
after the surgery; however, the TC sign reappeared in 3 patients who
developed progressive cholestasis after the procedure.
Conclusion. The TC sign is a simple, timesaving, and
reliable diagnostic tool in the evaluation of infants with infantile
cholestasis. The TC sign may also prove to be helpful in following
patients after hepatoportoenterostomy. We suggest a new diagnostic
strategy for patients suspected to have biliary atresia. When the TC
sign is visualized, the patient should undergo intraoperative
cholangiogram to confirm the diagnosis of biliary atresia, reserving
percutaneous liver biopsy for those patients in whom the TC sign could
not be detected.
Departments of
Pediatrics and Radiology, Mansoura University Children's Hospital,
Mansoura, Egypt; and § Departments of Pediatrics and Radiology, Upstate
Medical University, Syracuse, New York.
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