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Normograms for the Extrahepatic Bile Duct Diameter in Children

Feng, Albert*; O’hara, Sara M.; Gupta, Resmi; Fei, Lin; Lin, Tom K.§

Journal of Pediatric Gastroenterology and Nutrition: March 2017 - Volume 64 - Issue 3 - p e61–e64
doi: 10.1097/MPG.0000000000001372
Original Article: Hepatology

Objective: The normal diameter of the extrahepatic bile duct (EHD) in children has been poorly studied. Prior studies have enrolled small subject numbers, have studied only specific pediatric age groups, or have potential bias due to loosely defined exclusion criteria. We sought to establish parameters for the normal diameter of the EHD in children from birth to late adolescence, including premature infants.

Methods: A 12½-month institutional review board−approved, Health Insurance Portability and Accountability Act-compliant, retrospective chart review of all transabdominal ultrasounds performed on children (younger than 18 years) was conducted at a single pediatric tertiary referral center. Exclusion criteria included a past medical history of any pancreaticobiliary or hepatology disorder. New abnormal findings related to the liver, biliary system, or pancreas were also excluded. Recorded EHD measurements from review of the radiology reports were compiled. Estimated mean and 95% prediction intervals of EHD were calculated and reported for 6 nonoverlapping pediatric age groups.

Results: A total of 1016 ultrasounds on unique patients were included within the study. Estimated mean values and calculated 95% prediction intervals (in parentheses) for the diameter of the EHD were prematurity, 0.7 (0.3–1.7) mm; 0 to 2 months, 1.0 (0.4–2.3) mm; 3 to 11 months, 1.2 (0.5–2.9) mm; 1 to 4 years, 1.4 (0.6–3.3) mm; 5 to 12 years, 1.9 (0.8–4.3) mm; 13 to 17 years, 2.3 (1.0–5.2) mm.

Conclusions: Our derived data of normal predicted parameters of the EHD diameter in children of all age groups will help guide clinicians in identifying those patients outside the norm that may benefit from additional testing.

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*University of Cincinnati College of Medicine

Department of Radiology and Medical Imaging

Division of Biostatistics

§Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.

Address correspondence and reprint requests to Tom K. Lin, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., MLC 2010, Cincinnati, OH 45229 (e-mail:

Received 24 March, 2016

Accepted 2 August, 2016

The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

© 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,