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
Findings and procedure details
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 of bile duct walls may be seen in the setting of acute colangitis on contrast-enhanced CT.
MRI (Magnetic Resonance Cholangiopancreatography) shows:
- Intra and extrahepatic stones: T2 hypointense.
Diffusely v/s peripherally T1 hyperintense.
- Thickening of bile duct walls (T1WI C+)
- Central and extrahepatic duct dilatation.
There is frequently decreased arborization and abrupt tapering of peripheral ducts .
An advantage of MRCP compared to CT,
is the ability to visualize duct strictures which are usually short (less than 1 cm).
- Atrophic hepatic segments may be hypo-,
iso-,
or hyperintense to normal liver on T1 weighted images and iso- or hyperintense on T2-weighted images and are usually seen in association with crowded,
dilated ducts.
Complications of recurrent pyogenic cholangitis include hepatic abscess (up to 20% patients),
biloma and malignancy.
RPC is a well known risk factor for developing cholangiocarcinoma (up to 5% patients) and usually affects the atrophied segments or segments with a heavy stone burden.
Treatment:
- Biliary sepsis (acute cholangitis):
- Decompress infected biliary tree: endoscopic,
percutaneous,
drainage and stents.
2.
Clearance of calculi and debris: endoscopic,
percutaneous and surgery.
3.
Treatment of biliary stasis: endoscopic,
percutaneous and surgery.
Interventional radiology has a role in:
- Stricture dilation: Balloon cholangioplasty.
- Stone removal: Stone retrieval and intracorporeal lithotripsy.
- Drainage of the biliary ducts: stent placement.