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Kim YJ, Kim SH, Yoo SY, Kim JH, Jung SM, Lee S, Seo JM, Moon SH, Jeon TY. Comparison of Clinical and Radiologic Findings Between Perforated and Non-Perforated Choledochal Cysts in Children. Korean J Radiol 2022; 23:271-279. [PMID: 35029072 PMCID: PMC8814706 DOI: 10.3348/kjr.2021.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 10/08/2021] [Accepted: 10/28/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the clinical and radiologic findings between perforated and non-perforated choledochal cysts in children. MATERIALS AND METHODS Fourteen patients (mean age ± standard deviation, 1.7 ± 1.2 years) with perforated choledochal cysts (perforated group) and 204 patients (3.6 ± 3.8 years) with non-perforated choledochal cysts (non-perforated group) were included between 2000 and 2019. All patients underwent choledochal cyst excision after ultrasound, CT, or MR cholangiopancreatography. Relevant data including demographics, clinical symptoms, laboratory findings, imaging findings, and outcomes were analyzed. Statistical differences were compared using the Mann-Whitney U test and Fisher's exact test. RESULTS Choledochal cyst perforation occurred only in children under the age of 4 years. Acute symptoms, including fever (p < 0.001), were more common in the perforated group than in the non-perforated group. High levels of white blood cells (p = 0.004), C-reactive protein (p < 0.001), and serum amylase (p = 0.002), and low levels of albumin (p < 0.001) were significantly associated with the perforated group. All 14 patients with perforated choledochal cysts had ascites, whereas only 16% (33/204) of patients in the non-perforated group had ascites (p < 0.001). In the subgroup of patients who had ascites, a large amount of ascites (p = 0.001), increase in the amount of ascites in a short time (p < 0.001), complex ascites (p < 0.001), and perihepatic pseudocysts (p < 0.001) were more common in the perforated group than in the non-perforated group. CONCLUSION Children with perforated choledochal cysts have characteristic clinical and radiologic findings compared to those with non-perforated choledochal cysts. In young children with choledochal cysts, perforation should be differentiated in cases with acute symptoms, laboratory abnormalities, and characteristic ascites findings.
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Affiliation(s)
- Yu Jin Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Hyun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - So-Young Yoo
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Hye Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Min Jung
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sanghoon Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong-Meen Seo
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-Hoon Moon
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Tae Yeon Jeon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Grover SB, Malhotra S, Pandey S, Grover H, Kale R, Devra AG. Imaging diagnosis of a giant choledochal cyst in an infant. Radiol Case Rep 2021; 17:404-411. [PMID: 34925674 PMCID: PMC8649116 DOI: 10.1016/j.radcr.2021.10.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 02/05/2023] Open
Abstract
The usual etiologies of giant abdominal cystic masses in infants are mesenteric cyst, enteric duplication cyst, ovarian cyst in females, cystic lymphangioma, however, the presentation of a choledochal cyst in a gigantic form, is unusual. The primary modality for diagnosis of this entity is ultrasound, followed by MRI. The characteristic ultrasound features of a choledochal cyst are a well-defined cystic lesion which may be found to replace any segment of the biliary tree and is distinctly separate from the gallbladder. The associated anomalies are biliary atresia, gallbladder atresia, hepatic fibrosis and those of the pancreatico-biliary ductal system. MRI with MRCP has a conclusive role in confirming the ultrasound diagnosis. Choledochal cysts are currently classified as proposed by Todani et al, into five types. Herein, we report the case study of a 4-month-old male infant afflicted with a gigantic, Type1 Choledochal cyst, complicated by perforation, which was diagnosed by us at the first instance itself, using ultrasound examination and confirmed by MRI. The diagnosis was further confirmed at surgery and histopathology. The recommended treatment of cyst resection accompanied by a hepatico-jejunostomy bypass procedure, was successfully performed in the reported infant.
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Affiliation(s)
- Shabnam Bhandari Grover
- Department of Radiology and Imaging, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306 UP, India,Corresponding author. Shabnam B. Grover.
| | - Sonali Malhotra
- Department of Radiology and Imaging, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306 UP, India
| | - Saurabh Pandey
- Department of Radiology and Imaging, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306 UP, India
| | - Hemal Grover
- Department of Radiology & Imaging, Ichan School of Medicine at Mount Sinai West, New York, USA
| | - Ravi Kale
- Department of Pediatric Surgery, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306 UP, India
| | - Anshu Gupta Devra
- Department of Pathology, School of Medical Sciences and Research, Sharda Hospital, Sharda University, Greater Noida, 201306 UP, India
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Xin Y, Wang XM, Wang Y, Hu YX, Jia LQ. Value of Ultrasound in Diagnosing Perforation of Congenital Choledochal Cysts in Children. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2157-2163. [PMID: 33351216 DOI: 10.1002/jum.15604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This study aimed to investigate the diagnostic value of ultrasound in children with perforation of congenital choledochal cysts. METHODS Eligible patients recruited from January 2004 to December 2018 in our hospital were enrolled in this retrospective study. A total of 59 cases of congenital choledochal cysts with perforation were defined as the perforation group, and 100 cases of congenital choledochal cysts without perforation with similar symptoms were defined as the control group. Clinical features were analyzed and compared between the groups. The differential efficacy of varied diagnostic criteria was evaluated by a receiver operating characteristic analysis. RESULTS Significant differences were found between the groups with respect to clinical characteristics (abdominal pain, vomiting, fever, and abdominal distention; all P < .01) and the disease onset age (P < .001), but the diagnostic efficacy of both was poor (both areas under the curve, <0.7). The interruption of bile duct continuity only occurred in the perforation group with high specificity of 100% but poor sensitivity of 18.6%. The discrimination of combined features was significantly better (area under the curve, 0.936) than that of the disease onset age and clinical characteristics, with observed sensitivity and specificity of 93.2% and 94.0%, respectively. CONCLUSIONS Using specific features, ultrasound can effectively diagnose perforation of a congenital choledochal cyst in children.
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Affiliation(s)
- Yue Xin
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Xiao Man Wang
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yu Wang
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yan Xiu Hu
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Li Qun Jia
- Department of Ultrasound, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
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Kim D, Park S, Kim C, Yoon S, Choi J. Ultrasound-guided transhepatic computed tomography cholecystography in beagle dogs. J Vet Sci 2019; 20:e37. [PMID: 31364322 PMCID: PMC6669211 DOI: 10.4142/jvs.2019.20.e37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/30/2019] [Accepted: 05/13/2019] [Indexed: 02/03/2023] Open
Abstract
This study was performed to evaluate the feasibility of ultrasound-guided computed tomography (CT) cholecystography and to establish an optimal protocol. In 8 healthy beagles, CT cholecystography was conducted using four contrast formulas; two dilution ratios (1:1 vs. 1:3) and two total volumes (8 mL vs. 16 mL) of 300 mgI/kg iohexol after ultrasound-guided percutaneous contrast injection into the gallbladder. CT images were obtained at 3, 10, and 30 min after injection and assessed qualitatively and quantitatively. For all contrast formulas, CT cholecystography showed the gallbladder and the intra- and extrahepatic bile ducts. The volume of the gallbladder and size of bile duct were significantly larger when using a volume of 16 mL iohexol than an 8 mL volume regardless of the dilution ratio. The distinction between the common bile duct and duodenum, the filling of the gallbladder, and the patency of bile duct were effectively assessed using a 16 mL volume of contrast agent with either dilution ratio. Beam-hardening artifacts deteriorated CT image quality for visualizing the biliary system when using the dilution ratio of 1:1. Patency of the bile tract could be easily evaluated using a curvilinear planar reconstruction. There was no significant difference in CT scan time among the different conditions. Minor leakage of contrast agent temporarily occurred after contrast injection in 30% of 32 sets of CT cholecystography. Ultrasound-guided percutaneous cholecystography can visualize both gallbladder and biliary tract with minimal artifacts using a contrast agent volume of 16 mL with a 1:3 dilution ratio.
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Affiliation(s)
- Dongeun Kim
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Seungjo Park
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Cheolhyun Kim
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Sooa Yoon
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea
| | - Jihye Choi
- College of Veterinary Medicine and BK21 Plus Project Team, Chonnam National University, Gwangju 61186, Korea.
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Badru F, Litton T, Puckett Y, Bansal S, Guzman M, Vane D, Villalona GA. Spontaneous gallbladder perforation in a child secondary to a gallbladder cyst: a rare presentation and review of literature. Pediatr Surg Int 2016; 32:629-34. [PMID: 27062138 DOI: 10.1007/s00383-016-3891-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 12/19/2022]
Abstract
Spontaneous gallbladder perforation is rare in children. The etiology of gallbladder perforation varies greatly and is often unknown. Identified causes include infection, congenital, stones or choledochal cysts. Presently there are only five reported cases of spontaneous gallbladder perforation in children in the English literature. As such, the optimal method of diagnosis and management remains controversial. We report the case of a 2-year-old girl who presented with peritonitis secondary to spontaneous gallbladder perforation.
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Affiliation(s)
- F Badru
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, MO, 63104, USA.
| | - T Litton
- Department of Radiology, St Louis University Hospital, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Y Puckett
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, MO, 63104, USA
| | - S Bansal
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, MO, 63104, USA
| | - M Guzman
- Department of Pathology, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - D Vane
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, MO, 63104, USA
| | - G A Villalona
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, MO, 63104, USA
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