Supakul Nucharin

Final Pr. ID: Poster #: EDU-017

To summarize our experience using Computed Tomography Angiography (CTA) of the liver as an imaging tool for pre-living donor liver transplantation (LDLT) evaluation in biliary atresia (BA) patients. This pictorial review will illustrate and discuss several aspects of imaging techniques and the important findings that clinician need to know before LDLT.

Key imaging findings for vascular anatomy/collateral vessels will be made, emphasizing what clinicians need to know. Correlation with intraoperative findings will also be provided.
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Authors:  Supakul Nucharin

Keywords:  Biliary atresia, LDLT, liver transplantation, CTA liver, Pediatric

Chauhan Ankita,  Maller Vijetha

Final Pr. ID: Poster #: EDU-027

Biliary atresia is a progressive, fibro-obliterative disease of the intra- and extrahepatic bile ducts in infancy. This exhibit outlines the pathophysiology, diagnostic pathways, and current and emerging management strategies for biliary atresia in the pediatric age group. Read More

Authors:  Chauhan Ankita , Maller Vijetha

Keywords:  Biliary Atresia, Kasai, HIDA

Juang Eric,  Collard Michael,  Katz Danielle,  Adams Megan,  Wachs Michael,  Annam Aparna,  Zavaletta Vaz

Final Pr. ID: Poster #: EDU-048

Through a series of cases, this poster demonstrates how to diagnose and treat biliary anastomotic complications with image-guided techniques in infants after liver transplant.

We present several cases to illustrate the variability of biliary anastomoses including location, type, and number of anastomoses. Pediatric interventional radiologists and image-guided procedures are critical in the successful management of post-transplant biliary anastomotic strictures and leaks and minimize the need for invasive reoperation.

The selected cases illustrate complex image-guided percutaneous management of multiple duct anastomotic strictures, anastomotic dehiscence, cut surface leaks, and removal of surgically placed stents that may be malpositioned and/or causing obstruction. The interventional methods used to percutaneously manage these cases include complex biliary access utilizing snares, multiple drain placement, stent placement, and rendezvous procedures with endoscopic retrograde cholangiopancreatography.

The use of image-guided techniques by the pediatric interventional radiologist are invaluable in the management of biliary complications post-liver transplant in infants. Read More

Authors:  Juang Eric , Collard Michael , Katz Danielle , Adams Megan , Wachs Michael , Annam Aparna , Zavaletta Vaz

Keywords:  Transplant Interventions, Biliary, Image-Guided

Shet Narendra,  Flynn John,  Maloney Ezekiel,  Iyer Ramesh

Final Pr. ID: Poster #: EDU-021

The purpose of this review is to provide an overview of applications of Eovist in the pediatric population, as well as pitfalls. We will begin with an introduction on the origins of Eovist and how it and other hepatocyte specific contrast agents (HSCAs) differ from conventional gadolinium based contrast agents (GBCAs). We will then provide a sample of imaging protocols when Eovist is used for hepatic mass evaluation and for biliary indications. We will review benefits of Eovist in characterizing a variety of pediatric hepatic neoplasms, including hepatoblastoma, hepatocellular carcinoma, focal nodular hyperplasia, hepatic adenomas, and regenerative nodules, with mention of pathologies that do not follow traditional patterns (i.e., inflammatory adenomas). After this, we will cover biliary applications, including choledochal cysts, biliary obstruction, and postoperative bile leak. Finally, we will review some limitations of Eovist; notably, we will mention several scenarios where the hepatobiliary phase could not be achieved, and recommendations for how to approach these cases. Read More

Authors:  Shet Narendra , Flynn John , Maloney Ezekiel , Iyer Ramesh

Keywords:  Liver, Biliary, MRI

Ho Simon,  Sharma Priya

Final Pr. ID: Poster #: EDU-020

The aim of this exhibit is to review imaging findings of neonatal biliary disease, with emphasis on biliary atresia and conditions of surgical interest. We will present a series of cases on cholestatic diseases encountered in the neonatal period and multi-modality approach to imaging these patients.
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Authors:  Ho Simon , Sharma Priya

Keywords:  Cholestasis, Biliary Atresia

Van Antwerp Emily,  Makris Joseph

Final Pr. ID: Poster #: CR-024

Inspissated bile syndrome (IBS) is a rare pediatric condition, with an estimated incidence of 1 in 175,000 live births. It results from the thickening or "inspissation" of bile, often leading to biliary obstruction, cholestasis, and pale or acholic stools. While IBS is typically associated with predisposing factors such as prematurity, sepsis, total parenteral nutrition, or certain medications, it can occur without identifiable risk factors, as seen in this case. Early recognition and treatment are critical in preventing more serious complications such as liver dysfunction or cirrhosis. We report the case of a 4-week-old full-term infant (born at 40 weeks’ gestation) presenting with acholic (white) stools and mild jaundice. Initial laboratory tests showed a total bilirubin level of 5.0 mg/dL (3.9 direct), gamma-glutamyl transferase (GGT) of 352 U/L, alkaline phosphatase (ALP) of 586 U/L, and mildly elevated liver function tests. An abdominal ultrasound demonstrated intra- and extrahepatic biliary dilatation, with echogenic material obstructing the distal common bile duct just proximal to the ampulla, findings highly suggestive of inspissated bile syndrome. The patient was started on ursodiol 40 mg twice daily, a bile acid that promotes bile flow and decreases the viscosity of bile. A follow-up MRCP performed 10 days later showed complete resolution of the biliary obstruction and no evidence of intra- or extrahepatic dilation. This case highlights not only the rarity of IBS but also its ability to present in the absence of typical risk factors such as prematurity, malabsorption disorders, or prolonged total parenteral nutrition. Additionally, it underscores the essential role of imaging modalities such as ultrasound and MRCP in diagnosing biliary obstruction and guiding appropriate management. IBS should be considered in the differential diagnosis for any neonate presenting with jaundice and acholic stools, as timely diagnosis and medical management can lead to full recovery and prevent more serious hepatobiliary complications. Read More

Authors:  Van Antwerp Emily , Makris Joseph

Keywords:  Biliary, Abdominal Imaging, Abdominal Ultrasound

Qiu Cecil,  Donaldson James,  Rajeswaran Shankar,  Kim Stanley,  Superina Riccardo,  Mohammad Saeed,  Whitehead Bridget,  Green Jared

Final Pr. ID: Poster #: SCI-033

Biliary stenosis continues to be an important source of morbidity in pediatric liver transplantation. Percutaneous transhepatic cholangiography (PTC) with cholangioplasty and placement of an internal/external biliary drainage catheter has been the standard of care for biliary stenosis at our institution for over twenty years. The purpose of this article is to present the largest and most comprehensive pediatric series to date detailing the percutaneous management of liver transplants complicated by biliary stenosis. Read More

Authors:  Qiu Cecil , Donaldson James , Rajeswaran Shankar , Kim Stanley , Superina Riccardo , Mohammad Saeed , Whitehead Bridget , Green Jared

Keywords:  Liver transplant, PTC, Biliary stenosis

Patrick Ellen,  Dickson Paula,  Alazraki Adina,  Romero Rene

Final Pr. ID: Poster #: EDU-125

Ninety percent of biliary atresia cases occur with no associated anomalies. Ten percent of cases of biliary atresia are considered syndromic, occurring in association with a variety of congenital anomalies including heterotaxy, polysplenia, asplenia, congenital cardiac defects, intestinal malrotation, interrupted IVC, hepatic artery anomalies, and portal vein anomalies, including pre-duodenal portal vein. The incidence of hepatopulmonary syndrome is also increased in this group. Images from CT, MR, radiography, nuclear medicine, ultrasound and fluoroscopy will illustrate the variety of imaging appearances of the biliary atresia/splenic malformation syndrome. Read More

Authors:  Patrick Ellen , Dickson Paula , Alazraki Adina , Romero Rene

Keywords:  Biliary atresia, Splenic malformations

Di Puglia Elazir,  Correa Joao Antonio,  Penna Claudia

Final Pr. ID: Poster #: EDU-005 (S)

-To review the etiopathogenesis of biliary atresia;
-To review the techinique, describing and ilustratins typical and atypical sonographic findings ob biliary atresia, comparing them to the normal anatomy, to help the radiologist in the differencial diagnosisof cholestasis;
-To correlate the sonographic findings with laparoscopic cholangiography. Read More

Authors:  Di Puglia Elazir , Correa Joao Antonio , Penna Claudia

Keywords:  cholestasis, biliary atresia, ultrasound

Biscaye Stephanie,  Albertario Marco,  Guesmi Myriam,  Leloutre Beatrice,  Occelli Aurelie,  Boyer Corinne

Final Pr. ID: Poster #: CR-02 (R)

the aim of the study is to report the importance of the link between intracranial bleeding (ICB) and biliary atresia in neonates. Nowadays, the incidence of bleeding secondary to vitamin K deficiency has well-decreased, thanks to systematic vitamin K prophylaxis in neonates. However, ICB remains a severe complication of Vitamine K deficiency, with a high mortality rate and possible neurological disabilities.
Biliary atresia (BA) is a life-threatening condition in neonates, commonly diagnosed in the first 2 months of life, based on jaundice, cholestasis, pale-colored stools and dark urine. Occasionally, BA can be revealed later (25 to 65 days after birth), with severe symptoms such as intracranial, nasal or gastrointestinal bleedings. Read More

Authors:  Biscaye Stephanie , Albertario Marco , Guesmi Myriam , Leloutre Beatrice , Occelli Aurelie , Boyer Corinne

Keywords:  biliary atresia, intracranial bleeding