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Radiology
Biliary Anomalies
Built from Obstetric Imaging
What’s inside
10 sections · 93 slides
Overview
- What this topic covers
- Why bother looking for the gallbladder
The normal fetal gallbladder
Where it sits, when it appears, and how big it should be
- Where the gallbladder sits
- When it first shows up on the scan
- What a normal gallbladder looks like
- Normal fetal gallbladder beside the stomach
- How the gallbladder grows
- Not seeing the gallbladder is uncommon
- What an unseen gallbladder can mean
- What usually happens next
How the biliary tract is built
From a bud on the gut tube to a working drainage system
- The gallbladder starts as a bud
- From bud to plumbing
- Why the twelfth week matters
Five anomalies found before birth
What better ultrasound is now picking up
- The five prenatal biliary anomalies
- How to read the summary table
- Antenatally Detected Biliary Anomalies: Prenatal Ultrasound Findings
- Antenatally Detected Biliary Anomalies: MRI, Other Tests and Recommendations
Biliary atresia
Rare, hard to see before birth, and a race against the clock after it
- What biliary atresia is
- Why it is a race against time
- 0.2-0.5
- How common, and in whom
- Anomalies that travel with it
- What to check when biliary atresia is suspected
- Congenital Anomalies Associated With Syndromic Biliary Atresia
- Most cases stand alone
- What causes it
- How the newborn presents
- “
- Signs on the prenatal scan
- Ultrasound features to look for
- Potential Ultrasound Features of Fetal Biliary Atresia
- Biliary atresia with a cyst at the liver hilum
- A small distorted gallbladder beside a hilar cyst
- What is worth noticing on that image
- What MRI adds
- Cysts that look the same
- One more look-alike
- Cystic atresia or choledochal cyst?
- Before birth: what to do
- Testing the amniotic fluid: the timing window
- What the enzyme pattern tells you
- After birth: confirming the diagnosis
- The Kasai operation
- The biliary atresia pathway
Choledochal cysts
A balloon on the bile duct, and the hardest cyst to name before birth
- What a choledochal cyst is
- How the cyst is thought to form
- 1 : 100,000
- Who it affects
- Three ideas about the cause
- How children present
- What a late diagnosis costs
- On the prenatal scan
- Choledochal cyst beside a normal gallbladder
- The cyst sits next to a normal-looking gallbladder
- What is worth noticing on that image
- What Doppler and 3D add
- What MRI adds
- “
- Cysts that look the same
- Before birth: what to do
- After birth: confirm, then operate
Sludge and stones in the gallbladder
A third-trimester finding that usually comes to nothing
- What echogenic material means
- How often it is seen
- Does it mean something else is wrong?
- Why it forms
- Causes of gallstones in newborns
- What it looks like on ultrasound
- Echogenic material inside the fetal gallbladder
- Bright things that are not gallstones
- What to do about it
Duplication of the gallbladder
Two bags instead of one, and no cause for alarm
- What duplication means
- What it looks like on ultrasound
- Two gallbladders in the fetal right upper abdomen
- Other things that make two pockets
- What to do about it
An over-large gallbladder
Cholecystomegaly: when big is just big
- When is a gallbladder too big?
- How to use the normal size chart
- Normal Dimensions of the Fetal Gallbladder
- What it looks like on ultrasound
- Enlarged gallbladder in the third trimester
- Does a big gallbladder matter?
- What to do about it
Bringing it together
What to remember and what to say
- What the referring physician needs to know
- Key points: the normal gallbladder
- Key points: the cystic lesions
- “
- References
- References (continued)
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- References (continued)
- Obstetric Imaging: Fetal Diagnosis and Care, 2nd Edition