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Abdom Radiol (NY) 2022 May 18. Epub 2022 May 18.

Department of Radiology, Case Western Reserve University, Cleveland, OH, USA.

Sclerosing cholangitis is a chronic cholestatic disease characterized by stricturing, beading, and obliterative fibrosis of the bile ducts. Sclerosing cholangitis is considered primary (PSC) if no underlying etiology is identified or secondary (SSC) if related to another identifiable cause. In this article, we will review the clinical features, pathogenesis, diagnosis, and imaging findings of PSC and SSC, with an emphasis on features that may aid in the distinction of these entities. Read More

World J Gastroenterol 2021 Jan;27(4):371-376

Internal Medicine, Eunpyeong St. Mary's Hospital, Catholic University of Korea, Seoul 03312, South Korea.

Background: Duplication of the extrahepatic bile duct (DCBD) is an extremely rare congenital anomaly of the biliary system. There are five types of DCBD according to the latest classification. Among them, Type V is characterized by single drainage of the extrahepatic bile ducts. Read More

HPB (Oxford) 2018 11 14;20(11):1067-1072. Epub 2018 Jul 14.

Department of Surgery, The University of Hong Kong, 102 Pokfulam Road, Hong Kong, China.

Background: Recurrent pyogenic cholangitis (RPC) is a known risk factor for intrahepatic cholangiocarcinoma (ICC), whether it represents a poor prognostic factor remains controversial. The aim of this study was to investigate the post-hepatectomy oncological outcomes of patients with ICC and coexisting RPC.

Method: A retrospective analysis with propensity score matching (PSM) was performed for comparison between ICC patient with and without RPC. Read More

Abdom Radiol (NY) 2017 Dec;42(12):2964-2965

Department of Radiology, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, Hong Kong SAR.

Endoscopy 2017 Feb 9;49(S 01):E5-E6. Epub 2017 Jan 9.

Division of Gastroenterology and Hepatology, Weil Cornell Medical College, Cornell University New York, New York, USA.

Neth J Med 2016 Nov;74(9):401-405

Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, the Netherlands.

Oriental cholangiohepatitis is a condition occurring in the Asian population, characterised by recurrent bacterial cholangitis and presence of calculi within the intrahepatic bile ducts, biliary strictures and an increased risk for cholangiocarcinoma. It is an uncommon disease in the West that may not always be considered. The therapeutic approach is multidisciplinary and highly individual, and includes antibiotic therapy, endoscopic and percutaneous biliary drainage with stone removal and dilation of strictures, and in selected cases surgical resection of affected liver segments. Read More

Abdom Radiol (NY) 2017 01;42(1):46-56

Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore.

Recurrent pyogenic cholangitis (RPC) is an infective process involving the biliary tree typified by pigmented intraductal calculi with dilatation of the intra- and extrahepatic biliary tree. Previously endemic to South-east Asia, RPC can now be seen in Western countries with the increasing access to international travel and immigration. Affected patients are often plagued by recurrent bouts of cholangitis, and commonly suffer from complications such as abscess formation and biliary strictures. Read More

Dig Dis Sci 2016 Nov 24;61(11):3147-3150. Epub 2015 Nov 24.

Division of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, 300 Pasteur Drive, Suite H3680A, Stanford, CA, 94305, USA.

HPB (Oxford) 2016 10 28;18(10):821-826. Epub 2016 Jun 28.

Division of Surgical Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, 244 A. J. C. Bose Road, Kolkata, 700020, West Bengal, India.

Background: Although, recurrent pyogenic cholangitis (RPC) is prevalent in several parts of India, there is paucity of published literature from India. The aim of this study was to report on the short and long-term outcomes of surgery for RPC.

Methods: All the patients, who underwent surgery for RPC between August 2007 and February 2016 in the Department of Surgical gastroenterology, Institute of Postgraduate Medical Education and Research, Kolkata, India were retrospectively reviewed. Read More

J Emerg Med 2016 Oct 25;51(4):e79-e83. Epub 2016 Jul 25.

Department of Gastroenterology, Topiwala National Medical College and BYL Ch Hospital, Mumbai, Maharashtra, India.

Background: Acute encephalopathy in a patient with alcoholic liver disease (ALD) is a commonly encountered emergency situation occurring most frequently due to liver failure precipitated by varying etiologies. Acute reversible cerebellar ataxia with confusion secondary to prolonged metronidazole use has been reported rarely as a cause of encephalopathy in patients with ALD.

Case Report: We describe a decompensated ALD patient with recurrent pyogenic cholangitis associated with hepatolithiasis who presented to the emergency department with sudden-onset cerebellar ataxia with dysarthria and mental confusion after prolonged use of metronidazole. Read More

Abdom Radiol (NY) 2016 Mar;41(3):553-67

Department of Radiology, Northwestern University, NMH/Arkes Family Pavilion Suite 800, 676 N Saint Clair, Chicago, IL, 60611, USA.

Cholangiocarcinoma, a tumor of biliary epithelium, is increasing in incidence. The imaging appearance, behavior, and treatment of cholangiocarcinoma differ according to its location and morphology. Cholangiocarcinoma is usually classified as intrahepatic, perihilar, or distal. Read More

Korean J Radiol 2016 Jan-Feb;17(1):25-38. Epub 2016 Jan 6.

Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.

Sclerosing cholangitis is a spectrum of chronic progressive cholestatic liver disease characterized by inflammation, fibrosis, and stricture of the bile ducts, which can be classified as primary and secondary sclerosing cholangitis. Primary sclerosing cholangitis is a chronic progressive liver disease of unknown cause. On the other hand, secondary sclerosing cholangitis has identifiable causes that include immunoglobulin G4-related sclerosing disease, recurrent pyogenic cholangitis, ischemic cholangitis, acquired immunodeficiency syndrome-related cholangitis, and eosinophilic cholangitis. Read More

Eur Radiol 2016 Sep 22;26(9):3112-20. Epub 2015 Dec 22.

Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea.

Objectives: To evaluate thread sign of biliary intraductal papillary mucinous neoplasm (B-IPMN) on magnetic resonance imaging (MRI).

Methods: Thread sign was defined as intraductal linear or curvilinear hypointense striations. Two radiologists independently evaluated the presence and location of thread sign on MR cholangiography (thin-slice, thick-slab and 3D MRC) and axial MR images (T2 TSE, T2 HASTE and DWI) in patients with B-IPMN (n = 38) and in matched control groups with benign (n = 36) or malignant (n = 35) biliary diseases. Read More

Hum Pathol 2015 Mar 9;46(3):426-33. Epub 2014 Dec 9.

Department of Pathology, University of Chicago, Chicago, IL 60637. Electronic address:

The aim of this study was to review the clinical, radiographic, and pathologic features of cases of benign segmental cholangiectasia in non-Asian US patients with clinical concern for cholangiocarcinoma and compare these features with cases of recurrent pyogenic cholangitis (RPC) in Asian patients. A total of 10 non-Asian US patients with benign segmental cholangiectasia were included in this study. Nine of them underwent partial hepatic resection due to cholangiographic findings of segmental cholangiectasia with mural thickening and/or proximal biliary stricture. Read More

Radiographics 2014 May-Jun;34(3):565-86

From the Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (V.S.K.); and Department of Radiology, University of Pittsburgh Medical Center, Presby South Tower, Suite 4895, 200 Lothrop St, Pittsburgh, PA 15213 (A.K.D., N.D., K.H.).

Bile duct strictures in adults are secondary to a wide spectrum of benign and malignant pathologic conditions. Benign causes of bile duct strictures include iatrogenic causes, acute or chronic pancreatitis, choledocholithiasis, primary sclerosing cholangitis, IgG4-related sclerosing cholangitis, liver transplantation, recurrent pyogenic cholangitis, Mirizzi syndrome, acquired immunodeficiency syndrome cholangiopathy, and sphincter of Oddi dysfunction. Malignant causes include cholangiocarcinoma, pancreatic adenocarcinoma, and periampullary carcinomas. Read More

Ann Hepatol 2012 Mar-Apr;11(2):268-71

Department of Gastroenterology, Ankara Education and Research Hospital, Ankara, Turkey.

Recurrent pyogenic cholangitis is endemic to South-east Asia but has been very rarely reported from natives of other parts of the world. A 43-years-old woman was presented with sepsis that had a history of recurrent epigastric pain and fever attacks. Her liver tests were unremarkable suggesting any hepatobiliary diseases. Read More

Abdom Imaging 2012 Oct;37(5):767-74

Health Promotion Center, Asan Medical Center, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, Korea.

Purpose: To assess MR findings and diagnostic performance for differentiating malignant from benign hepatic masses in recurrent pyogenic cholangitis (RPC).

Materials And Methods: During a recent 6-year period, we performed MRI in 352 patients with RPC. Among them, 58 had confirmed hepatic masses; cholangiocarcinoma (n = 15), abscess (n = 37), inflammatory pseudotumor (n = 3), biloma (n = 3). Read More

Eur J Gastroenterol Hepatol 2011 Sep;23(9):770-7

Division of Gastroenterology and Hepatology, Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong.

Background: Recurrent pyogenic cholangitis (RPC) is recognized as an important cause of pyogenic liver abscesses (PLA). Although it is endemic to Southeast Asia, it is seen increasing in the west mainly owing to immigration. The aim of this study is to compare the clinical characteristics of PLA in patients with RPC and without RPC. Read More

Korean J Radiol 2011 May-Jun;12(3):269-79. Epub 2011 Apr 25.

Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.

Liver fluke disease is a chronic parasitic inflammatory disease of the bile ducts. Infection occurs through ingestion of fluke-infested, fresh-water raw fish. The most well-known species that cause human infection are Clonorchis sinensis, Opisthorchis viverrini and Opisthorchis felineus. Read More

Semin Liver Dis 2011 Feb 22;31(1):33-48. Epub 2011 Feb 22.

Department of Pathology, Caritas Medical Centre, Hong Kong, China.

Primary hepatothiasis (HL) and recurrent pyogenic cholangitis (RPC) are two terms describing the different aspects of the same disease, with HL emphasizing the pathologic changes and RPC emphasizing the clinical presentation and suppurative inflammation. It is predominantly a disease of the Far East. In the 1960s, it was the third most common cause of emergency abdominal surgery at a university hospital in Hong Kong. Read More

Clin Radiol 2011 Feb 15;66(2):158-63. Epub 2010 Oct 15.

Department of Radiodiagnosis and Imaging, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, India.

Oriental cholangiohepatitis (OCH) also called recurrent pyogenic cholangitis is characterized by intrahepatic duct calculi, strictures, and recurrent infections. In turn cholangitis can result in multiple hepatic abscesses, further biliary strictures, and in severe cases, progressive hepatic parenchymal destruction, cirrhosis, and portal hypertension. Magnetic resonance cholangiopancreatography (MRCP) and conventional T1-weighted (T1W) and T2-weighted (T2W) magnetic resonance imaging (MRI) findings have been described in patients with OCH. Read More

AJR Am J Roentgenol 2009 Jan;192(1):W28-35

Department of Radiology, Vancouver General Hospital, 899 W 12th Ave., Vancouver, BC V5Z 1M9, Canada.

Objective: The objective of this article is to familiarize the reader with the sonographic, CT, MR cholangiopancreatography, and ERCP appearances of recurrent pyogenic cholangitis and to briefly review the role of interventional radiology in the management of this disease.

Conclusion: Recurrent pyogenic cholangitis is a complex disease, the incidence of which is increasing in Western countries. Radiologists should be aware of the role of imaging in the diagnosis of this disease and the use of imaging as a guideline for subsequent intervention. Read More

Radiographics 2008 Jul-Aug;28(4):1115-29

Department of Radiology, Mallinckrodt Institute of Radiology, St Louis, MO, USA.

Cholangiocarcinoma is the second most common primary malignant hepatobiliary neoplasm, accounting for approximately 15% of liver cancers. Diagnosis of cholangiocarcinoma is challenging and the prognosis is uniformly poor, with recurrence rates of 60%-90% after surgical resection. A wide spectrum of neoplastic and nonneoplastic conditions of the biliary tract may masquerade as cholangiocarcinoma, adding to the complexity of management in patients suspected to have cholangiocarcinoma. Read More

Curr Gastroenterol Rep 2007 Apr;9(2):156-64

Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, 1041, Sector 24-B, Chandigarh 160 023, India.

Parasitic infestations of the biliary tract are a common cause of biliary obstruction in tropical countries and can lead to such serious complications as cholangitis and cholangiocarcinoma. Endoscopic therapy has helped in the management of biliary complications caused by these parasites. Ascaris lumbricoides organisms, which normally reside in the jejunum, are actively motile and can invade the papilla, thus migrating into the bile duct and causing biliary obstruction. Read More

J Hepatobiliary Pancreat Surg 2007 30;14(1):98-113. Epub 2007 Jan 30.

Department of Surgery, Teikyo University Chiba Medical Center, 3426-3 Anesaki, Ichihara, Chiba, 299-0111, Japan.

Unusual cases of acute cholecystitis and cholangitis include (1) pediatric biliary tract infections, (2) geriatric biliary tract infections, (3) acalculous cholecystitis, (4) acute and intrahepatic cholangitis accompanying hepatolithiasis (5) acute biliary tract infection accompanying malignant pancreatic-biliary tumor, (6) postoperative biliary tract infection, (7) acute biliary tract infection accompanying congenital biliary dilatation and pancreaticobiliary maljunction, and (8) primary sclerosing cholangitis. Pediatric biliary tract infection is characterized by great differences in causes from those of adult acute biliary tract infection, and severe cases should be immediately referred to a specialist pediatric surgical unit. Because biliary tract infection in elderly patients, who often have serious systemic conditions and complications, is likely to progress to a serious form, early surgery or biliary drainage is necessary. Read More

AJR Am J Roentgenol 2006 Dec;187(6):1571-7

Department of Radiology, Soonchunhyang University Hospital, 657 Hannam-Dong, Youngsan-Ku, Seoul, South Korea 140-743.

Objective: The purpose of our study was to determine the characteristic CT findings of cholangiocarcinoma associated with recurrent pyogenic cholangitis.

Conclusion: CT findings of cholangiocarcinoma associated with recurrent pyogenic cholangitis are important in order to improve early diagnosis and proper treatment. Cholangiocarcinoma associated with recurrent pyogenic cholangitis is predominantly located in the atrophic hepatic lobes and in the hepatic lobes of biliary calculi and is associated with the narrowing or obliteration of the portal vein. Read More

Eur Radiol 2006 Nov 16;16(11):2612-4. Epub 2006 Sep 16.

Department of Radiology, The Adelaide and Meath Hospital incorporating The National Children's Hospital, Tallaght, Dublin, 24, Ireland.

Recurrent pyogenic cholangitis is a common disease in Southeast Asia, where an association with the liver fluke Clonorchis sinensis is postulated. It is characterised by repeated attacks of cholangitis with multiple recurrences of bile duct stones and strictures. We present a case of recurrent pyogenic cholangitis due to chronic infestation with Clonorchis sinensis in a young Asian immigrant, describing its radiological appearances and also therapeutic strategies with a review of additional examples from the literature. Read More

Radiographics 2004 Jul-Aug;24(4):1117-35

Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Ontario, Canada.

Acute cholecystitis is the most common cause of acute pain in the right upper quadrant (RUQ), and urgent surgical removal of the gallbladder is the treatment of choice for uncomplicated disease. However, cross-sectional imaging is essential because more than one-third of patients with acute RUQ pain do not have acute cholecystitis. In addition, patients with complications of acute cholecystitis, such as perforation, are often best treated with supportive measures initially and elective cholecystectomy at a later date. Read More

J Comput Assist Tomogr 2004 Jul-Aug;28(4):523-7

Department of Radiology, University of California at San Francisco, San Francisco, CA 94143-0628, USA.

Objective: To describe the multidetector computed tomography (CT) findings in 3 patients with atypical gallstone ileus.

Methods: We retrospectively evaluated computed radiography and CT images from three cases of surgically proven gallstone ileus. Two radiologists evaluated by consensus all images for the presence of ectopic gallstone, small bowel obstruction, intrahepatic pneumobilia, cholecystic pneumobilia. Read More