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Neonatal Cholestasis

Case Detail

Anatomy: Gastrointestinal
Joseph Junewick, MD FACR
Diagnostic Category: Metabolic
Created: over 10 years ago
Updated: over 10 years ago
Tags: PEDS
Modality/Study Types: US
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3 month old with recent aortic coactation repair now with jaundice and elevated direct bilirubin.

Case Images


Neonatal Cholestasis


US – 1) echogenic bile and gallstone in gall bladder, 2) minimal mural thickening of gall bladder although the gall bladder is partially contracted, 3) dilated extra-hepatic bile ducts, and 4) tumefactive bile in distal common bile duct.


Cholestasis is related to elevated levels of conjugated (direct) bilirubin. Clinically, jaundice is green compared to jaundice due to unconjugated
hyperbilirubinemia which is yellow. Conjugated bilirubin is not toxic.

Cholestasis may be secondary to hepatocellular disease such as infection (neonatal hepatitis, viral, TORCH, bacterial), total parenteral nutrition, hepatic ischemia, erythroblastosis fetalis, or metabolic disease (alpha-1-antitrypsin, cystic fibrosis, glycogen storage disease, etc). Cholestasis may also be secondary to biliary tree anomalies such as biliary atresia, Alagille’s syndrome, choledochal cyst, and bile plug syndrome.

Inspissated bile syndrome or bile plug syndrome is an uncommon cause of jaundice in neonates. Sludge may be seen within the gallbladder and extrahepatic ducts as low-level echoes within the lumen. Inspissated bile is slightly more echogenic but does not cause shadowing. Partial or complete biliary ductal obstruction can occur. I


Gubernick JA, Rosenberb HK, Ilaslan H, Kessler A. US Approach to Jaundice in Infants and Children. Radiographics 2000; 20:173-195.


Linda Woolpert, RT, RDMS

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