Pediatric Interventions

Session: Educational Exhibit Presentations - Station 10: Pediatric Interventions/Portal Hypertension/Practice Development

Transcholecystic Cholangiogram for Neonatal Hyperbilirubinemia: Techniques and Spectrum of Imaging Findings

Monday, March 6, 2023

5:10 PM – 5:15 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

Sarah Khoncarly, MD

VIR Fellow
University of Michigan, Michigan Medicine

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Joseph J. Gemmete, MD, FACR, FSIR, FCIRSE, FAHA

Professor
Michigan Medicine
Mamadou Sanogo, MD

Attending Physician
University of Michigan
Jason Grove, PA-C

Pediatric IR Physician Assistant
University of Michigan
CH

Caitlin Hughes, PA-C

Pediatric IR Physician Assistant
University of Michigian, Michigian Medicine
MJ

Marcus Jarboe, MD

Attending Pediatric Surgeon
University of Michigan
WS

William Sherk, MD

Clinical Assistant Professor, Interventional Radiology
University of Michigan Hospital

Disclosure(s):

Sarah Khoncarly, MD: No financial relationships to disclose

Joseph J. Gemmete, MD, FACR, FSIR, FCIRSE, FAHA: No financial relationships to disclose

Mamadou Sanogo, MD: No financial relationships to disclose

William Sherk, MD: No financial relationships to disclose

Learning Objectives:

1. Describe technical considerations for sonographic gallbladder identification and percutaneous access in neonates with hyperbilirubinemia

2. Identify potential complications with and alternatives to transcholecystic cholangiography

3. Review the differential diagnosis of neonatal hyperbilirubinemia and the spectrum of imaging findings on cholangiography

Background:

Infants with persistent cholestasis and conjugated hyperbilirubinemia require expedited evaluation to exclude biliary atresia. Although the historical gold standard for diagnosis of biliary atresia has been intraoperative cholangiography, this requires laparotomy, which can be problematic for critically ill neonates who are not ideal surgical candidates. Percutaneous approaches such as transcholecystic cholangiography (TCC) can offer a safe, minimally invasive alternative for these high-risk neonates.

Clinical Findings/Procedure Details:

Here we present our institutional experience of patients that highlight the utility and efficacy of TCC. We discuss clinical manifestations as well as the interventional radiologist’s role in the diagnostic stratification of neonatal hyperbilirubinemia. A comprehensive pictorial review of proper pre-procedural work up, indications, contraindications, imaging findings and technical considerations for TCC are presented. Using a case-based format, procedural steps are outlined, and potential pitfalls and complications are emphasized.

Conclusion and/or Teaching Points:

Interventional radiologists can play a pivotal role in the diagnosis and management of neonatal hyperbilirubinemia. In the case where surgery is not a reasonable option for the patient, TCC is a safe, effective, minimally invasive alternative. With knowledge of basic principles of TCC and a firm understanding of potential pitfalls, interventional radiologist can be equipped to manage even the smallest of patients.