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Case of the Month

July 2008

Patient Data: 4 weeks old female

Clinical Info: Jaundice


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Transverse image of the liver with dilatated intrahepatic bile ducts with intraluminal reflective structures (arrows)


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Transverse image of the liver with color doppler confirming absent flow in the intrahepatic ducts. The arrows point to intraluminal structures in the biliary ducts.


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Longitudinal image of the gallbladder with intraluminal material


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Longitudinal image of the gallbladder with intraluminal masses also in the neck (double arrows) with the same echogenicity as the structures in the intrahepatic ducts.


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Longitudinal image of the common bile duct showing 3 rounded intraluminal structures


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Another longitudinal image of the common bile duct showing multiple rounded intraluminal structures.

All the structures in the biliary tract show no acoustic shadowing and have the appearance of inspisated bile and sludge balls.
The patient was referred to a pediatric university center. The diagnosis was confirmed: Biliary tract dilatation caused by inspisated bile and sludge balls.
Because the patient was treated with antibiotics for a urinary tract infection prior to the onset of the jaundice and no other predisposing factor for biliary tract sludge and stone formation was found, it was presumed that this was the cause of the sludge formation.
Common causes for biliary tract sludge and stone formation in the very young pediatric patients are parenteral nutrition, dehydration, infection and cephalosporin treatment.
The patient could be treated conservatively and the jaundice disappeared.

See also case of the month September 2005


References
Klar A, Branski D, Akerman Y, Nadjari M, Berkun Y, Moise J, Shazberg G, Revel-Vilk S, Israeli T, Katz G, Levy A, Ami AB, Hurvitz H J Sludge ball, pseudolithiasis, cholelithiasis and choledocholithiasis from intrauterine life to 2 years: a 13-year follow-up.
Pediatr Gastroenterol Nutr. 2005 Apr;40(4):477-80.

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