Case Report

DISIDA Scan

Case I

Name: 劉亦承

Age: 2 m/o

Sex: Male

Chief complain

Prolonged jaundice since birth

Present illness A case of full-term(BBW:3400gm;NSD) born Jaundice was noted since he was 3-4 d/o. After going home, pale looking and jaundice

was still noted. Impaired liver function (GOT/GPT:76/50) and

hyperbilirubinemia (Bil(T/D):4.6/2.7) Abdominal echo revealed hepatomegaly.

Physical examination Cons: alert; conj: pale; sclera: not icteric HEENT: np Neck: supple, LAP(-) Chest: symmetric expansion HS:RHB, no murmur BS: no rale Abdominal: soft, ovoid, BS: normoactive ; Liver :2fb below RCM Limbs: free movable

Differential Diagnosis Common:

1. Biliary atresia

2. Neonatal hepatitis

Uncommon: 1. Sepsis

2. Infectious hepatitis(TORCH, syphilis, HBV, Rubella)

3. Alpha-1 Antitrypsin Deficiency)

4. Other causes for high-grade obstruction

Plan HbsAg AFP TORCH + VDRL, α1-antitrypsin CMV (urine):- ; CMV (serum): + Rub IgG: + Liver biopsy Ultrasound DISIDA

Liver Biopsy

Fatty metamorphosis, cholestasis and the presence of giant cells transformation.

Portal areas are still shown, without bile ductules proliferation.

Abdominal Echo Liver: homogenous parenchyma and

enlarged size GB and bile duct: normal Portal vein and hepatic vein: normal Pancreases and spleen: normal Ascites:Nil; no occupy lesion is noted.

IMP: Hepatomegaly

Tc 99m DISIDA cholescintigraphy

Indication Evaluation cholecysitis Differentiate between obstructive and

nonobstructive jaundice Investigate persons with upper abdominal

pain Biliary assessment postsurgery and

evaluation of biliary atresia

Normal DISIDA sacn

Biliary atresia

IMP: low probability of biliary atresia.

Biliary atresia ＆ Neonatal hepatitis Does not have true

hepatocellular dysfunction such that tracer accumulation in the liver should be normal.

Bowel activity should not been seen.

Abnormal liver function leading to depressed hepatocellular accumulation of tracer and delayed transit through the liver.

Bowel activity will eventually been seen

Definite Diagnosis

Neonatal hepatitis

Case II Name: 呂彥霖

Age: 1m 4d/o

Sex: Male

Chief Compliance

Prolonged jaundice since birth

Present Illness

This 1m 4d/o male infant was born on 90-04-14.

Prolonged jaundice was found later. He was brought to LMD and then was

referred to our CNU due to elevated bilirubin level. (Bil(T/D):5.6/1.8)

Physical Examination Cons: alert; sclera: mild icteric Neck: supple, LAP (-) Chest: symmetric expansion HS: RHB, no murmur BS: clear Abd: Liver: 2cm below RCM Spleen: just palpable Limbs: free movable ; No pitting edema

Tc 99m DISIDA cholescintigraphy Good hepatic uptake on the 5 min image Homogeneous radiotracer distribution of liver on

the 15 min image. Visualized radioactivity of GB on the 30-min

image. Relatively low amount of intestinal radioactivity

on the serial one and six hours images. Persistent hepatic radioactivity on the 24 hour

image.

Impression

Impaired bile passage, partial biliary atresia is considered.

Functional GB.

MRCP Revealed visible common bile duct The gall bladder was roughly 3 cm in

length Intrahepatic ducts were not dilated No abnormal signal intensity lesion in the

liver parenchyma. Imp: No definite evidence of biliary atresia