Pseudo Gallbladder sign in biliary atresia—an imaging pitfall

• Published in: Pediatric radiology 2011-05, Vol.41 (5), p.620-626
• Main Authors: Aziz, Seerat, Wild, Yvette, Rosenthal, Philip, Goldstein, Ruth B.
• Format: Article
• Language: English
• Subjects: Biliary Atresia - diagnostic imaging; Cholestasis - diagnostic imaging; Diagnosis, Differential; Female; Gallbladder - diagnostic imaging; Humans; Imaging; Infant; Infant, Newborn; Male; Medicine; Medicine & Public Health; Neuroradiology; Nuclear Medicine; Oncology; Original; Original Article; Pediatrics; Radiology; Retrospective Studies; Ultrasonography; Ultrasound
• ISSN: 0301-0449; 1432-1998
• DOI: 10.1007/s00247-011-2019-1

Background Ultrasound (US) is used to identify causes of neonatal cholestasis. We describe a potential sonographic pitfall, the “pseudo gallbladder,” in biliary atresia (BA). Objective To describe the Pseudo Gallbladder sign (PsGB sign) . Materials and methods Sonograms/clinical records of 20 confirmed BA infants and 20 non-BA cases were reviewed retrospectively. For the BA group, preoperative sonography and surgical and pathological findings were examined. For the non-BA group, sonographic features and pathological findings were examined. The PsGB sign is defined as a fluid-filled structure, located in the expected region of the gallbladder, measuring ≤ 15 mm in length but without a well-defined or normal-appearing gallbladder wall. Results A recognizable gallbladder and normal gallbladder wall were present in all non-BA infants. However, none of the BA infants had a sonographically normal gallbladder. Seventy-three percent of BA patients had a PsGB, and in 27% no gallbladder or gallbladder-like structure was detected. Conclusion A gallbladder-like structure in BA is common and can be misinterpreted as a normal gallbladder, delaying diagnosis and therapy. Recognition of this imaging pitfall, described here as the pseudo gallbladder sign, will help avoid this error.