J Korean Soc Radiol.  2010 Jun;62(6):533-540.

Acute Cholangitis without Biliary Obstruction: Causes and Radiologic Features

Affiliations
  • 1Department of Radiology, Dong-A University, College of Medicine, Busan, Korea. risual@dau.ac.kr

Abstract

PURPOSE
The aim of this study is to determine the causes of acute cholangitis without the biliary obstruction and radiological findings.
MATERIALS AND METHODS
This study was performed retrospectively. A total of 135 patients diagnosed with acute cholangitis in a clinical setting based on the review of the radiologic findings from an ultrasonogram (USG), computed tomogram (CT), or magnetic resonance images (MRI). Among them, patients with a biliary obstruction as a result of a stone, tumor, lymph node, stricture were excluded. A total of 31 patients had acute cholangitis without a definite biliary obstruction. We analyzed their causes and imaging features with the USG and CT image.
RESULTS
The causes of acute cholangitis without biliary obstruction included Clonorchis sinensis cholangitis in 15 cases (48%), post-operative swelling after gastrojejunostomy, pylorus preserved partial duodenectomy, and choledochojejunostomy in 7 cases (22.6%), recent spontaneous passage of a distal CBD stone in 3 cases (9.7%), compression effect by the large duodenal diverticulum in 2 cases (6.5%), and unknown causes in 4 cases (12.9%).
CONCLUSION
Acute cholangitis may be associated without a distal biliary obstruction. USG, CT, or MR imaging can provide precise information as well as help to differentiate the causes of acute cholangitis.


MeSH Terms

Acute Disease
Cholangitis
Choledochostomy
Clonorchis sinensis
Constriction, Pathologic
Diverticulum
Gastric Bypass
Humans
Lymph Nodes
Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Pylorus
Retrospective Studies
Tomography, X-Ray Computed

Figure

  • Fig. 1 68-year-old man with mild infestation of clonorchis sinensis. A. Transverse scan of left hepatic lobe shows severe dilatation of bile ducts with echogenic bands (between arrows) along dilated bile ducts, indicating severe fibrous thickening of wall. B. The common bile duct is not specific (arrow). C, D. CT scan shows diffuse mild uniform dilatation in both peripheral intrahepatic ducts and periductal fibrous tissue is enhanced (arrows).

  • Fig. 2 Acute suppurative cholangitis caused by duodenal reflux after Billroth type I anastomosis in a 72-year-old man with abdominal pain, a high fever, and jaundice. A, B. Contrast-enhanced CT images show profound dilatation of bile ducts with periductal (arrows) and pericapsular (arrowhead) enhancement. C. Transverse ultrasonogram shows diffuse hyperechoic thickening of the gallbladder wall-a finding indicative of acute inflammation (arrow). D. Both intrahepatic ducts show also diffuse dilatated with hyperechoic thickening (arrows).

  • Fig. 3 43-year-old woman with epigastric pain. A. Coronal reformated contrast-enhanced fat-suppressed T1-weighted image shows mild dilatation in common bile duct with wall thickening and enhancement (arrow). B. Abnormal mass or stone is not noted in distal common bile duct. C. In ultrasound, common bile duct shows wall thickening at transverse scan (arrows). D. 2 days ago, axial non-contrast CT scan checked in local clinic shows small calcified stone (arrow) in distal common bile duct

  • Fig. 4 Acute suppurative cholangitis caused by duodenal diverticulum in a 70-year-old man with abdominal pain, a high fever, and jaundice A, B. Axial contrast enhanced fat-suppressed T1-weighted images show mild dilatated both intrahepatic ducts (arrow) and common bile duct with wall thickening (arrowhead) and periductal prominent enhancement. C, D. At distal common bile duct level, large air filled duodenal diverticulum (arrow) is noted with indent distal common bile duct (arrowhead). His symptom was relieved after diverticulectomy.


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