Define recurrent pyogenic cholangitis and its epidemiology. Review the main clinical features and differential diagnosis of recurrent pyogenic cholangitis. Discussthe imaging findings by CT and MRI including initial presentation and complications. Review the goals of treatment.

Recurrent pyogenic cholangitis (RPC), also known as Oriental cholangiohepatitis, is characterized by recurrent episodes of cholangitis associated with intrahepatic pigmented stones. This entity is found primarily in residents and former residents of East Asia although there has been a significant increase in the prevalence of recurrent pyogenic cholangitis in Western countries because of migration from endemic regions.In Barcelona there has been anincreasingnumber ofChineseimmigrants mainly from the region of Qingtian since 1980. RPC occurs between the third and fifth decades; no specific sex predilection exists. The...

Imaging manifestations of recurrent pyogenic cholangitis include biliary strictures, ductal wall thickening secondary to fibrosis and intraductal pigmented stones. CT findings include: Dilatation of the first- and second-order ducts, with nondilated peripheral ducts. The presence of hepatolithiasis is easier to detect on unenhanced CT. Pneumobilia is a frequent finding and does not necessarily suggests previous intervention altough many patients have a history of previous surgery or endoscopic intervention (ERCP). Hepatic parenchymal atrophy is usually present and occurs most frecuently in the left lateral segments. Enhancement...

The incidence of recurrent pyogenic cholangitis is increasing in Western Countries and it is important that radiologists be familiar with cross-sectional and MRCP findings so that the diagnosis is considered when a patient from an endemic area presents withthe classic clinical features of upper abdominal pain, fever and jaundice. A multimodal imaging approach is essential to proper diagnosis, assessment of complications and treatment. Interventional radiology has an importante role in the multi-disciplinary approach of the disease.

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