Biliary atresia echocardiography or ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Saud Khan M.D.


Ultrasonography shows a hypoplastic or absent gallbladder. Prandial state is not relevant to testing. Non filling of the gallbladder can be seen. The triangular cord sign described by Park et al. can be visualised.

Key Ultrasound Findings in biliary atresia

On abdominal ultrasound, biliary atresia shows:

  • echogenic fibrous tissue anterior to the portal vein: triangular cord sign showing a solid proximal biliary remnant anterior to the bifurcation of the portal vein. [1]
    • It represents the remnant of the extrahepatic bile duct
  • Changes of the hepatic artery
    • larger hepatic artery caliber [2]
    • Doppler showing subcapsular hepatic arterial flow
    • right proximal hepatic artery diameter >1.5 mm
    • hepatic artery to portal vein diameter ratio >0.45
  • gallbladder ghost triad [3]

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  1. Lee HJ, Lee SM, Park WH, Choi SO (2003). "Objective criteria of triangular cord sign in biliary atresia on US scans". Radiology. 229 (2): 395–400. doi:10.1148/radiol.292020472. PMID 14595143.
  2. Lee MS, Kim MJ, Lee MJ, Yoon CS, Han SJ, Oh JT; et al. (2009). "Biliary atresia: color doppler US findings in neonates and infants". Radiology. 252 (1): 282–9. doi:10.1148/radiol.2522080923. PMID 19561262.
  3. Tan Kendrick AP, Phua KB, Ooi BC, Tan CE (2003). "Biliary atresia: making the diagnosis by the gallbladder ghost triad". Pediatr Radiol. 33 (5): 311–5. doi:10.1007/s00247-003-0867-z. PMID 12695863.