ascending cholangitis or acute cholangitis.
Bacterial infection of the biliary tree in the presence of complete or partial bile duct obstruction is called ascending cholangitis, acute cholangitis, bacterial cholangitis,
The CT findings that can be seen in patients with ascending cholangitis include
1-dilatation of the intra- and extrahepatic bile ducts,
2-increased attenuation of the bile because of the presence of intraductal debris,
3-diffuse and concentric bile duct wall thickening,
4-gas in the bile ducts or portal veins, and
5- intrahepatic abscesses (seen as low-attenuation areas in contiguity with the intrahepatic bile ducts).
MRI can show a similar spectrum of findings (Fig. ). Because bile duct dilatation can be absent in patients with acute or partial obstruction, there is no correlation between the presence and degree of bile duct dilatation and the severity of acute cholangitis. However, the presence of hepatic abscesses, pneumobilia, and portal venous gas are indicative of a poor prognosis.
Reference:BiblioMed Textbook-Computed Body Tomography
Intrahepatic cholangiocarcinoma. Capsular retraction and the late enhancement
Early and late phase enhancement of a intrahepatic cholangiocarcinoma
On the CT the liver looks quite normal.
Todani Classification:
ERCP: Caroli disease with severe intrahepatic duct dilatation. No obstruction. Mild dilatation of the choledochal duct due to cholangitis
When we put on the color doppler, we will notice that these structures contain blood flow and represent portal veins.
multicystic water density structures(arrow) are noted peripherally connected to a dilated bile duct(open arrow).
same as above.
T2 MRI image revealed hyper-intense cystic structure(arrow).
on T1MRI image ,it becomes hypo-intense.
showed bile dilatation in the left lobe and anterior segment of the right lobe with biloma(B) in the lateral segment of the left lobe.
left lobe bile duct dilatation with evidence of soft tissue mass(arrow) seen anterior to portal vein at the site of the common bile duct.
percutaneous trans hepatic cholangiogram showed
-G=multiple filling defects are seen in gall bladder suggestin calculi.
arrow=pneumobilia after PROCEDURE.
another case of cholangio-carcinoma
ERCP showed irregular borders of bile ducts(arrow head)and the band like structures(straight arrows) of the intra hepatic ducts with the paucity of side branches corresponding to apperance
thickening of right and left hepatic ducts(arrows).
1-In the evaluation of patients with PSC, CT has a role complementary to that of cholangiography. Computed tomography is not as sensitive as cholangiography for detecting the subtle mucosal abnormalities of the bile ducts, and therefore it should not be used as a screening examination in patients suspected of having PSC. However, the multiple, tight bile duct strictures in PSC can preclude adequate evaluation of the intrahepatic bile ducts with cholangiography; it is in this group of patients that CT can be helpful in evaluating the extent of disease.
look to the image and describe
