Point-of-Care Ultrasound Evaluation of Biliary Atresia in the Pediatric Emergency Department

Persistent jaundice in a newborn infant past 2 weeks of age requires timely evaluation for cholestasis or unconjugated hyperbilirubinemia. Untreated biliary atresia may result in death within a year of age and is the most common cause of death in children with liver disease. It is also the most common indication for liver transplantation in children when Kasai hepatic portoenterostomy fails. Ultrasound is the primary initial imaging modality for suspected biliary atresia, primarily looking for absence of the gallbladder and the triangular cord sign, with a thickened echogenic anterior wall of the right portal vein (EARPV measuring >4 mm). We report a case in which point-of-care ultrasound was used to evaluate suspected biliary atresia and expedite care, with the diagnosis subsequently confirmed by liver biopsy and surgery.