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Recurrent Pyogenic Cholangitis
Cody Keller, MD; Aya Kamaya, MD, FSRU, FSAR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Recurrent pyogenic cholangitis (RPC)
            • Synonyms

              • Hepatolithiasis, oriental cholangiohepatitis (no longer used)
            • Definitions

              • Recurrent episodes of acute pyogenic cholangitis with intra- and extrahepatic biliary pigment stones

            IMAGING

            • General Features

              • Ultrasonographic Findings

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Nuclear Medicine Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                • Gross Pathologic & Surgical Features

                                  • Microscopic Features

                                    CLINICAL ISSUES

                                    • Presentation

                                      • Demographics

                                        • Natural History & Prognosis

                                          • Treatment

                                            DIAGNOSTIC CHECKLIST

                                            • Consider

                                              • Image Interpretation Pearls

                                                Selected References

                                                1. Chen G et al: Right posteroinferior bile duct angulation correlates with bile duct stone occurrence in patients with hepatolithiasis. Abdom Radiol (NY). 45(10):3103-8, 2020
                                                2. Ma WJ et al: Biliary antibiotics irrigation for E. coli-induced chronic proliferative cholangitis and hepatolithiasis: a pathophysiological study in rabbits. Clin Res Hepatol Gastroenterol. 44(3):356-67, 2020
                                                3. Lee JM et al: Disease of the Gallbladder and Biliary Tree. In Hodler J et al: Diseases of the Abdomen and Pelvis 2018-2021: Diagnostic Imaging -IDKD Book [Internet]. Springer, 49-56, 2018
                                                4. Yao D et al: Lipopolysaccharide stimulates endogenous β-glucuronidase via PKC/NF-κB/c-myc signaling cascade: a possible factor in hepatolithiasis formation. Mol Cell Biochem. 444(1-2):93-102, 2018
                                                5. Kwan KEL et al: Recurrent pyogenic cholangitis: a review of imaging findings and clinical management. Abdom Radiol (NY). 42(1):46-56, 2017
                                                6. Khuroo MS et al: Hepatobiliary and pancreatic ascariasis. World J Gastroenterol. 22(33):7507-17, 2016
                                                7. Buxbaum J et al: Multidisciplinary treatment of cystic fibrosis-related recurrent pyogenic cholangitis (CF-RPC). Dig Dis Sci. 60(6):1801-4, 2015
                                                8. Fang CH et al: Computer-aided rigid choledochoscopy lithotripsy for hepatolithiasis. J Surg Res. 195(1):105-12, 2015
                                                9. Kim HJ et al: Cholangiocarcinoma risk as long-term outcome after hepatic resection in the hepatolithiasis patients. World J Surg. 39(6):1537-42, 2015
                                                10. Yang Q et al: Effects of epidermal growth factor receptor inhibitor on proliferative cholangitis in hepatolithiasis. Hepatobiliary Pancreat Dis Int. 14(5):509-15, 2015
                                                11. Co M et al: Surgical management of recurrent pyogenic cholangitis: 10 years of experience in a tertiary referral centre in Hong Kong. HPB (Oxford). 16(8):776-80, 2014
                                                12. Katabathina VS et al: Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. Radiographics. 34(3):565-86, 2014
                                                13. Menias CO et al: Mimics of cholangiocarcinoma: spectrum of disease. RadioGraphics 28: 1115-29; 2008
                                                14. Park HS et al: CT Differentiation of cholangiocarcinoma from periductal fibrosis in patients with hepatolithiasis. AJR Am J Roentgenol. 187(2):445-53, 2006
                                                15. Jeyarajah DR: Recurrent pyogenic cholangitis. Curr Treat Options Gastroenterol. 7(2):91-8, 2004
                                                16. Chan FL et al: Modern imaging in the evaluation of hepatolithiasis. Hepatogastroenterology. 44(14):358-69, 1997
                                                17. Lim JH: Oriental cholangiohepatitis: pathologic, clinical, and radiologic features. AJR Am J Roentgenol. 157(1):1-8, 1991
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Abbreviations

                                                            • Recurrent pyogenic cholangitis (RPC)
                                                          • Synonyms

                                                            • Hepatolithiasis, oriental cholangiohepatitis (no longer used)
                                                          • Definitions

                                                            • Recurrent episodes of acute pyogenic cholangitis with intra- and extrahepatic biliary pigment stones

                                                          IMAGING

                                                          • General Features

                                                            • Ultrasonographic Findings

                                                              • Radiographic Findings

                                                                • CT Findings

                                                                  • MR Findings

                                                                    • Nuclear Medicine Findings

                                                                      • Imaging Recommendations

                                                                        DIFFERENTIAL DIAGNOSIS

                                                                          PATHOLOGY

                                                                          • General Features

                                                                            • Staging, Grading, & Classification

                                                                              • Gross Pathologic & Surgical Features

                                                                                • Microscopic Features

                                                                                  CLINICAL ISSUES

                                                                                  • Presentation

                                                                                    • Demographics

                                                                                      • Natural History & Prognosis

                                                                                        • Treatment

                                                                                          DIAGNOSTIC CHECKLIST

                                                                                          • Consider

                                                                                            • Image Interpretation Pearls

                                                                                              Selected References

                                                                                              1. Chen G et al: Right posteroinferior bile duct angulation correlates with bile duct stone occurrence in patients with hepatolithiasis. Abdom Radiol (NY). 45(10):3103-8, 2020
                                                                                              2. Ma WJ et al: Biliary antibiotics irrigation for E. coli-induced chronic proliferative cholangitis and hepatolithiasis: a pathophysiological study in rabbits. Clin Res Hepatol Gastroenterol. 44(3):356-67, 2020
                                                                                              3. Lee JM et al: Disease of the Gallbladder and Biliary Tree. In Hodler J et al: Diseases of the Abdomen and Pelvis 2018-2021: Diagnostic Imaging -IDKD Book [Internet]. Springer, 49-56, 2018
                                                                                              4. Yao D et al: Lipopolysaccharide stimulates endogenous β-glucuronidase via PKC/NF-κB/c-myc signaling cascade: a possible factor in hepatolithiasis formation. Mol Cell Biochem. 444(1-2):93-102, 2018
                                                                                              5. Kwan KEL et al: Recurrent pyogenic cholangitis: a review of imaging findings and clinical management. Abdom Radiol (NY). 42(1):46-56, 2017
                                                                                              6. Khuroo MS et al: Hepatobiliary and pancreatic ascariasis. World J Gastroenterol. 22(33):7507-17, 2016
                                                                                              7. Buxbaum J et al: Multidisciplinary treatment of cystic fibrosis-related recurrent pyogenic cholangitis (CF-RPC). Dig Dis Sci. 60(6):1801-4, 2015
                                                                                              8. Fang CH et al: Computer-aided rigid choledochoscopy lithotripsy for hepatolithiasis. J Surg Res. 195(1):105-12, 2015
                                                                                              9. Kim HJ et al: Cholangiocarcinoma risk as long-term outcome after hepatic resection in the hepatolithiasis patients. World J Surg. 39(6):1537-42, 2015
                                                                                              10. Yang Q et al: Effects of epidermal growth factor receptor inhibitor on proliferative cholangitis in hepatolithiasis. Hepatobiliary Pancreat Dis Int. 14(5):509-15, 2015
                                                                                              11. Co M et al: Surgical management of recurrent pyogenic cholangitis: 10 years of experience in a tertiary referral centre in Hong Kong. HPB (Oxford). 16(8):776-80, 2014
                                                                                              12. Katabathina VS et al: Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. Radiographics. 34(3):565-86, 2014
                                                                                              13. Menias CO et al: Mimics of cholangiocarcinoma: spectrum of disease. RadioGraphics 28: 1115-29; 2008
                                                                                              14. Park HS et al: CT Differentiation of cholangiocarcinoma from periductal fibrosis in patients with hepatolithiasis. AJR Am J Roentgenol. 187(2):445-53, 2006
                                                                                              15. Jeyarajah DR: Recurrent pyogenic cholangitis. Curr Treat Options Gastroenterol. 7(2):91-8, 2004
                                                                                              16. Chan FL et al: Modern imaging in the evaluation of hepatolithiasis. Hepatogastroenterology. 44(14):358-69, 1997
                                                                                              17. Lim JH: Oriental cholangiohepatitis: pathologic, clinical, and radiologic features. AJR Am J Roentgenol. 157(1):1-8, 1991