Type:
Educational Exhibit
Keywords:
Infection, Abscess, Stents, Drainage, Dilation, Ultrasound, MR-Cholangiography, CT, Interventional non-vascular, Biliary Tract / Gallbladder, Abdomen
Authors:
N. Martinez, C. Sitges, J. C. Pernas; Barcelona/ES
DOI:
10.26044/ecr2019/C-0808
Background
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 an increasing number of Chinese immigrants mainly from the region of Qingtian since 1980.
RPC occurs between the third and fifth decades; no specific sex predilection exists.
The exact aetiology is not well established,
but there is a strong association with hepatobiliary infestation with Clonorchis sinensis or Ascaris lumbricoides.
Patients usually present with recurrent episodes of upper abdominal pain,
fever and jaundice.
Laboratory findings are non specific and usually include leukocytosis and mildly elevated bilirubin and alkaline phosphatase.
The differential diagnosis includes: Acute Cholangitis,
Pyogenic Hepatic Abscess,
Mirizzi Syndrome,
Primary Sclerosing Cholangitis,
Cholangiocarcinoma.
None of the imaging features of recurrent pyogenic cholangitis is pathognomonic of the condition.
The correct diagnosis may be considered by correlating imaging findings (especially the presence of hepatolithiasis) with clinical and demographic features.