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Ischemic Bile Duct Injury
Siva P. Raman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Ischemic cholangitis, ischemic cholangiopathy
          • Definitions

            • Nonanastomotic biliary strictures in liver allograft originally described in setting of hepatic artery thrombosis (HAT) or stenosis (HAS) but now known to occur due to wide variety of other microangiopathic and immunologic injuries
            • Associated with biliary cast syndrome, development of solid bilirubin casts in biliary tree, which result in biliary obstruction

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Staging, Grading, & Classification

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Alabdulghani F et al: Radiological findings in ischaemic cholangiopathy. Clin Radiol. 75(3):1618, 2020
                                          2. Goria O et al: Ischemic cholangiopathy: an update. Clin Res Hepatol Gastroenterol. 44(4):486-90, 2020
                                          3. Lemmers A et al: Biliary cast syndrome after liver transplantation: a cholangiographic evolution study. J Gastroenterol Hepatol. ePub, 2020
                                          4. Menon S et al: Large-duct cholangiopathies: aetiology, diagnosis and treatment. Frontline Gastroenterol. 10(3):284-91, 2019
                                          5. Luo Y et al: Graft cholangiopathy: etiology, diagnosis, and therapeutic strategies. Hepatobiliary Pancreat Dis Int. 13(1):10-7, 2014
                                          6. Mourad MM et al: Etiology and management of hepatic artery thrombosis after adult liver transplantation. Liver Transpl. 20(6):713-23, 2014
                                          7. Imam MH et al: Secondary sclerosing cholangitis: pathogenesis, diagnosis, and management. Clin Liver Dis. 17(2):269-77, 2013
                                          8. Itri JN et al: Hepatic transplantation: postoperative complications. Abdom Imaging. 38(6):1300-33, 2013
                                          9. Yang YL et al: Biliary casts after liver transplantation: morphology and biochemical analysis. World J Gastroenterol. 19(43):7772-7, 2013
                                          10. Cursio R et al: Ischemia-reperfusion injury and ischemic-type biliary lesions following liver transplantation. J Transplant. 2012:164329, 2012
                                          11. Kinner S et al: Biliary complications after liver transplantation: addition of T1-weighted images to MR cholangiopancreatography facilitates detection of cast in biliary cast syndrome. Radiology. 263(2):429-36, 2012
                                          12. Collettini F et al: Ischemic-type biliary lesions after ortothopic liver transplantation: diagnosis with magnetic resonance cholangiography. Transplant Proc. 43(7):2660-3, 2011
                                          13. Kirchner GI et al: Outcome of patients with ischemic-like cholangiopathy with secondary sclerosing cholangitis after liver transplantation. Scand J Gastroenterol. 46(4):471-8, 2011
                                          14. Park YS et al: Hepatic arterial stenosis assessed with doppler US after liver transplantation: frequent false-positive diagnoses with tardus parvus waveform and value of adding optimal peak systolic velocity cutoff. Radiology. 260(3):884-91, 2011
                                          15. Katz LH et al: Magnetic resonance cholangiopancreatography for the accurate diagnosis of biliary complications after liver transplantation: comparison with endoscopic retrograde cholangiography and percutaneous transhepatic cholangiography - long-term follow-up. Clin Transplant. 24(5):E163-9, 2010
                                          16. Singh AK et al: Postoperative imaging in liver transplantation: what radiologists should know. Radiographics. 30(2):339-51, 2010
                                          17. Deltenre P et al: Ischemic cholangiopathy. Semin Liver Dis. 28(3):235-46, 2008
                                          18. Gelbmann CM et al: Ischemic-like cholangiopathy with secondary sclerosing cholangitis in critically ill patients. Am J Gastroenterol. 102(6):1221-9, 2007
                                          19. Verdonk RC et al: Nonanastomotic biliary strictures after liver transplantation, part 2: management, outcome, and risk factors for disease progression. Liver Transpl. 13(5):725-32, 2007
                                          20. Buis CI et al: Causes and consequences of ischemic-type biliary lesions after liver transplantation. J Hepatobiliary Pancreat Surg. 13(6):517-24, 2006
                                          21. Ward J et al: Bile duct strictures after hepatobiliary surgery: assessment with MR cholangiography. Radiology. 231(1):101-8, 2004
                                          22. Quiroga S et al: Complications of orthotopic liver transplantation: spectrum of findings with helical CT. Radiographics. 21(5):1085-102, 2001
                                          23. Ward EM et al: Hilar biliary strictures after liver transplantation: cholangiography and percutaneous treatment. Radiology. 177(1):259-63, 1990
                                          24. Zajko AB et al: Cholangiographic findings in hepatic artery occlusion after liver transplantation. AJR Am J Roentgenol. 149(3):485-9, 1987
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Synonyms

                                                    • Ischemic cholangitis, ischemic cholangiopathy
                                                  • Definitions

                                                    • Nonanastomotic biliary strictures in liver allograft originally described in setting of hepatic artery thrombosis (HAT) or stenosis (HAS) but now known to occur due to wide variety of other microangiopathic and immunologic injuries
                                                    • Associated with biliary cast syndrome, development of solid bilirubin casts in biliary tree, which result in biliary obstruction

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Ultrasonographic Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Staging, Grading, & Classification

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Alabdulghani F et al: Radiological findings in ischaemic cholangiopathy. Clin Radiol. 75(3):1618, 2020
                                                                                  2. Goria O et al: Ischemic cholangiopathy: an update. Clin Res Hepatol Gastroenterol. 44(4):486-90, 2020
                                                                                  3. Lemmers A et al: Biliary cast syndrome after liver transplantation: a cholangiographic evolution study. J Gastroenterol Hepatol. ePub, 2020
                                                                                  4. Menon S et al: Large-duct cholangiopathies: aetiology, diagnosis and treatment. Frontline Gastroenterol. 10(3):284-91, 2019
                                                                                  5. Luo Y et al: Graft cholangiopathy: etiology, diagnosis, and therapeutic strategies. Hepatobiliary Pancreat Dis Int. 13(1):10-7, 2014
                                                                                  6. Mourad MM et al: Etiology and management of hepatic artery thrombosis after adult liver transplantation. Liver Transpl. 20(6):713-23, 2014
                                                                                  7. Imam MH et al: Secondary sclerosing cholangitis: pathogenesis, diagnosis, and management. Clin Liver Dis. 17(2):269-77, 2013
                                                                                  8. Itri JN et al: Hepatic transplantation: postoperative complications. Abdom Imaging. 38(6):1300-33, 2013
                                                                                  9. Yang YL et al: Biliary casts after liver transplantation: morphology and biochemical analysis. World J Gastroenterol. 19(43):7772-7, 2013
                                                                                  10. Cursio R et al: Ischemia-reperfusion injury and ischemic-type biliary lesions following liver transplantation. J Transplant. 2012:164329, 2012
                                                                                  11. Kinner S et al: Biliary complications after liver transplantation: addition of T1-weighted images to MR cholangiopancreatography facilitates detection of cast in biliary cast syndrome. Radiology. 263(2):429-36, 2012
                                                                                  12. Collettini F et al: Ischemic-type biliary lesions after ortothopic liver transplantation: diagnosis with magnetic resonance cholangiography. Transplant Proc. 43(7):2660-3, 2011
                                                                                  13. Kirchner GI et al: Outcome of patients with ischemic-like cholangiopathy with secondary sclerosing cholangitis after liver transplantation. Scand J Gastroenterol. 46(4):471-8, 2011
                                                                                  14. Park YS et al: Hepatic arterial stenosis assessed with doppler US after liver transplantation: frequent false-positive diagnoses with tardus parvus waveform and value of adding optimal peak systolic velocity cutoff. Radiology. 260(3):884-91, 2011
                                                                                  15. Katz LH et al: Magnetic resonance cholangiopancreatography for the accurate diagnosis of biliary complications after liver transplantation: comparison with endoscopic retrograde cholangiography and percutaneous transhepatic cholangiography - long-term follow-up. Clin Transplant. 24(5):E163-9, 2010
                                                                                  16. Singh AK et al: Postoperative imaging in liver transplantation: what radiologists should know. Radiographics. 30(2):339-51, 2010
                                                                                  17. Deltenre P et al: Ischemic cholangiopathy. Semin Liver Dis. 28(3):235-46, 2008
                                                                                  18. Gelbmann CM et al: Ischemic-like cholangiopathy with secondary sclerosing cholangitis in critically ill patients. Am J Gastroenterol. 102(6):1221-9, 2007
                                                                                  19. Verdonk RC et al: Nonanastomotic biliary strictures after liver transplantation, part 2: management, outcome, and risk factors for disease progression. Liver Transpl. 13(5):725-32, 2007
                                                                                  20. Buis CI et al: Causes and consequences of ischemic-type biliary lesions after liver transplantation. J Hepatobiliary Pancreat Surg. 13(6):517-24, 2006
                                                                                  21. Ward J et al: Bile duct strictures after hepatobiliary surgery: assessment with MR cholangiography. Radiology. 231(1):101-8, 2004
                                                                                  22. Quiroga S et al: Complications of orthotopic liver transplantation: spectrum of findings with helical CT. Radiographics. 21(5):1085-102, 2001
                                                                                  23. Ward EM et al: Hilar biliary strictures after liver transplantation: cholangiography and percutaneous treatment. Radiology. 177(1):259-63, 1990
                                                                                  24. Zajko AB et al: Cholangiographic findings in hepatic artery occlusion after liver transplantation. AJR Am J Roentgenol. 149(3):485-9, 1987