الفهرس | Only 14 pages are availabe for public view |
Abstract Diffuse liver diseases in pediatrics can be categorized as: hepatitis and autoimmune hepatitis, cholestatic liver diseases, liver cirrhosis and chronic liver diseases, metabolic liver diseases vascular liver diseases and fibrocystic liver diseases. In our study we prospectively tried to show if multidetector CT study can add to the clinical and pathological diagnosis of diffuse hepatic diseases in neonates, infants and children. The study population consisted of 20 neonates and infants , 10 males and 10 females whose ages ranged from one day to one year (mean age 4.86 months) and 53 children 37 males and 36 females whose ages ranged from one year to 18 years (mean age 3.79 years). All patients underwent detailed history taking including symptoms and signs of diffuse liver diseases and laboratory investigations, ultrasonography and MDCT of the abdomen and pelvis. Histopathological examination was done for 61 patients. The most common clinical presentation in neonates and infants was jaundice while a symptomatic patients were the least. In children, the most common clinical presentation was jaundice, while multiple neck swellings, hypoactivity, epistaxis and easy fatigue were less common. The abdominal ultrasound examination of the studied group showed that (20%) of neonates and infants had hepatosplenomegally while (80%) showed average size of the liver and spleen. (40%) of the studied children had hepatomegaly, while (66 %) showed average size of the liver. Average spleen size was detected in (52.8%) of the children, while (47.5%) showed splenomegaly. Liver cirrhosis was detected in Summary (16.9%) of the children, focal lesions in (13.2%), cirrhotic liver with focal lesions in (5.6%) and coarse liver with focal lesion in (5.6%). CT showed hepatomegally in (20%) of the studied neonates and infants; while (100%) of them had smooth liver surface and homogenous liver parenchyma. Average spleen was detected in (80%), while (20%) showed splenomegaly. (80%) showed normal biliary radicals while they were unremarkable in (20%). Portovenous system was normal in (85%) of patients while it was attenuated in (15%) of them. On the other hand (66%) of the studied children showed enlarged liver, irregular liver surface in (34%) and coarse parenchyma in (28%) of them. Biliary radicals were dilated in (11.2%), porta hepatis lymph nodes were enlarged in (20.8%), the porto venous system was dilated in (5.7%) while ascites was found in (39.6%) Intrahepatic cholestasis was the most common histopathological finding among neonates, infants and children. According to the pathogenesis, cholestatic liver disease was the most common cause of diffuse liver diseases among neonates and infants (60%) followed by metabolic liver diseases (20%) and vascular liver diseases (20%); while in the studied children, hepatitis was the most common cause (20.8%) followed by metabolic liver disease (17.5%), structural liver disease (17%), liver cirrhosis (17%), vascular liver disease (15.1%), cholestatic liver disease (15.1%) and autoimmune hepatitis (15.1%). The correlation between the pathogenesis and CT findings in the studied neonates and infants showed that hepatosplenomegally was most common among patients diagnosed as metabolic liver disease. The correlation between the pathogenesis and CT findings in the studied children showed that hepatomegally and irregular liver surface were most common among patients diagnosed as having vascular liver disease (87.5%), while low attenuation parenchyma was most common among patients with metabolic liver disease (55.6%). Summary In neonates and infants CT was diagnostic in vascular liver disease but it was unable to diagnose metabolic liver disease nor cholestatic liver disease. In conclusion, our study showed that MDCT of the abdomen did not have a great additive value in the diagnosis of diffuse liver disease, but was of value in the diagnosis of vascular liver diseases in neonates and infants. Nevertheless it had a good diagnostic value in structural and vascular liver diseases in children. Liver biopsy and histopathological study is still of prime importance for the exact diagnosis. |