Case 320

Case 320

Medical history

Female patient, 8 years old, admitted due to severe diffuse abdominal pain started 7 days ago. The mother informs that the pain is recurrent since 2 years old, associated with vomiting, constipation and occasions in which the child gets yellowed skin and darkened urine. On physical examination, the child is icteric and has a palpable mass in the right hypochondrium. Ultrasonography (US) of the liver and biliary tract was performed on admission.

Image 1: Ultrasonography of liver and biliary tract, gallbladder and proximal choledochus region, transverse and longitudinal sections.

Image 2: Ultrasonography of liver and bile ducts, proximal choledochus region, oblique transverse section.

Image 3: Ultrasonography of the liver and biliary ducts, distal bile duct region.

Based on the pictures and clinical history described, which diagnosis is most likely?

Test question

(UFU – 2016) Raul, 40 days, is brought to the clinic for being yellow. He was born of normal birth, in term, birth weight equal to 3200g, in good condition. Discharged from hospital with his mom. Mother has reported jaundice since the first week of life, having made use of Picão tea. She sought the doctor when he had fifteen days and it was prescribed guided sunbath and replaced human milk by starting formula. Baby is icteric +++ / 4, hydrated, with globular abdomen, liver 4 cm from the right costal margin and spleen 3 cm from the left costal margin, Current weight = 4 kg. No further changes. During the visit he presented darkened urine and whitish feces.

All of the following may be possible diagnoses, except: