Enlarged hepatic hilar lymph node: an additional ultrasonographic feature that may be helpful in the diagnosis of biliary atresia

  • Zongjie Weng
  • Luyao Zhou
  • Qiumei Wu
  • Wenying Zhou
  • Hong Ma
  • Yifan Fang
  • Tingting Dang
  • Min LiuEmail author



To prospectively assess whether the detection of hepatic hilar lymph nodes (LNs) contributes to the diagnosis of biliary atresia (BA).


A total of 80 jaundiced infants were enrolled in this study and had abdominal ultrasound (US). The hepatic hilar LNs, the gallbladder classification, and the triangular cord (TC) thickness of all infants were evaluated. The area under the receiver operating characteristic curve (AUROC) analysis, t tests, and chi-squared tests were used to compare US signs between infants with BA and those without BA.


BA was found in 45 patients and excluded in 35 patients. The length of the hepatic hilar LNs in infants with BA (median with interquartile range, 11 mm (8, 13.5)) was significantly greater than that in infants without BA (0 mm (0, 0)) (p < 0.001). The AUROCs of the enlarged hepatic hilar LNs, gallbladder classification, and TC thickness were 0.867, 0.894, and 0.832, respectively. The accuracy of LNs (87.5%) in the diagnosis of BA was close to that of the gallbladder classification scheme (88.8%) (p = 0.049) and was higher than that of the TC thickness (82.5%) (p = 0.031). The enlarged LNs had the highest sensitivity (93.3%) in distinguishing BA from non-BA.


The presence of enlarged hepatic hilar LNs is an additional highly sensitive sign for the noninvasive diagnosis of BA. Through the combination of enlarged LNs, gallbladder classification, and TC thickness, most BA could be identified.

Key Points

• An enlarged hepatic hilar LN is an additional US sign for the noninvasive diagnosis of biliary atresia.

• Combining enlarged hepatic hilar LNs, gallbladder classification, and TC thickness, BA could be diagnosed in most infants.


Biliary atresia Lymph nodes Ultrasonography Gallbladder 



Biliary atresia


Triangular cord




Lymph nodes


Hepatic portoenterostomy


Area under receiver operating characteristic curves



This study was supported by the Fujian Natural Science Foundation (No: 2017J01235), Fujian Provincial Maternity and Children’s Hospital Science and Technology Innovation Startup Fund (No: Maternal and Child YXCM 18-20), and the National Natural Science Foundation of China (No: 81501480).

Compliance with ethical standards


The scientific guarantor of this publication is Min Liu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• Prospective

• Diagnostic study or prognostic study

• Performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Zongjie Weng
    • 1
  • Luyao Zhou
    • 2
  • Qiumei Wu
    • 1
  • Wenying Zhou
    • 2
  • Hong Ma
    • 3
  • Yifan Fang
    • 4
  • Tingting Dang
    • 1
  • Min Liu
    • 1
    Email author
  1. 1.Department of Medical Ultrasonics, Fujian Provincial Maternity and Children’s HospitalAffiliated Hospital of Fujian Medical UniversityFuzhou CityPeople’s Republic of China
  2. 2.Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, the First Affiliated HospitalSun Yat-Sen UniversityGuangzhouPeople’s Republic of China
  3. 3.Department of Pathology, Fujian Provincial Maternity and Children’s HospitalAffiliated Hospital of Fujian Medical UniversityFuzhou CityPeople’s Republic of China
  4. 4.Department of Pediatric Surgery, Fujian Provincial Maternity and Children’s HospitalAffiliated Hospital of Fujian Medical UniversityFuzhou CityPeople’s Republic of China

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