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Gastrointestinal
Diagnosis
Biliary System
Infection
Recurrent Pyogenic Cholangitis
Recurrent Pyogenic Cholangitis
Siva P. Raman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Recurrent pyogenic cholangitis (RPC)

          • Synonyms

            • Oriental cholangitis, oriental cholangiohepatitis, intrahepatic pigment stone disease
            • Biliary obstruction syndrome of Chinese/Hong Kong disease

          • Definitions

            • Disease characterized by formation of pigment stones throughout biliary tree with resultant biliary strictures and repeated bouts of cholangitis

          IMAGING

          • General Features

            • Fluoroscopic Findings

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Nuclear Medicine Findings

                      • Other Modality 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. Gupta A et al: Recurrent pyogenic cholangitis. StatPearls, 2021
                                                2. 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
                                                3. Kwan KEL et al: Recurrent pyogenic cholangitis: a review of imaging findings and clinical management. Abdom Radiol (NY). 42(1):46-56, 2017
                                                4. Lee KH et al: The arrowhead appearance of bile ducts in recurrent pyogenic cholangitis. Abdom Radiol (NY). 42(12):2964-5, 2017
                                                5. Furtado R et al: Recurrent pyogenic cholangitis. ANZ J Surg. 85(6):491-2, 2015
                                                6. Katabathina VS et al: Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. Radiographics. 34(3):565-86, 2014
                                                7. Tsui WM et al: Hepatolithiasis and the syndrome of recurrent pyogenic cholangitis: clinical, radiologic, and pathologic features. Semin Liver Dis. 31(1):33-48, 2011
                                                8. Tsui WM et al: Primary hepatolithiasis, recurrent pyogenic cholangitis, and oriental cholangiohepatitis: a tale of 3 countries. Adv Anat Pathol. 18(4):318-28, 2011
                                                9. Wani NA et al: MRI of oriental cholangiohepatitis. Clin Radiol. 66(2):158-63, 2011
                                                10. Heffernan EJ et al: Recurrent pyogenic cholangitis: from imaging to intervention. AJR Am J Roentgenol. 192(1):W28-35, 2009
                                                11. Jain M et al: MRCP findings in recurrent pyogenic cholangitis. Eur J Radiol. 66(1):79-83, 2008
                                                12. Menias CO et al: Mimics of cholangiocarcinoma: spectrum of disease. Radiographics. 28(4):1115-29, 2008
                                                13. Kim JH et al: CT findings of cholangiocarcinoma associated with recurrent pyogenic cholangitis. AJR Am J Roentgenol. 187(6):1571-7, 2006
                                                14. Safar F et al: Magnetic resonance T1 gradient-echo imaging in hepatolithiasis. Abdom Imaging. 30(3):297-302, 2005
                                                15. Hanbidge AE et al: From the RSNA refresher courses: imaging evaluation for acute pain in the right upper quadrant. Radiographics. 24(4):1117-35, 2004
                                                16. Lee WJ et al: Radiologic spectrum of cholangiocarcinoma: emphasis on unusual manifestations and differential diagnoses. Radiographics. 21 Spec No:S97-S116, 2001
                                                17. Park MS et al: Recurrent pyogenic cholangitis: comparison between MR cholangiography and direct cholangiography. Radiology. 220(3):677-82, 2001
                                                18. Cosenza CA et al: Current management of recurrent pyogenic cholangitis. Am Surg. 65(10):939-43, 1999
                                                19. Kim MJ et al: MR imaging findings in recurrent pyogenic cholangitis. AJR Am J Roentgenol. 173(6):1545-9, 1999
                                                20. Yoon KH et al: Inflammatory pseudotumor of the liver in patients with recurrent pyogenic cholangitis: CT-histopathologic correlation. Radiology. 211(2):373-9, 1999
                                                21. Harris HW et al: Recurrent pyogenic cholangitis. Am J Surg. 176(1):34-7, 1998
                                                22. Leow CK et al: Re: Biliary access procedure in the management of oriental cholangiohepatitis. Am Surg. 64(1):99, 1998
                                                23. Lee DW et al: Biliary infection. Baillieres Clin Gastroenterol. 11(4):707-24, 1997
                                                24. Lo CM et al: The changing epidemiology of recurrent pyogenic cholangitis. Hong Kong Med J. 3(3):302-4, 1997
                                                25. Sperling RM et al: Recurrent pyogenic cholangitis in Asian immigrants to the United States: natural history and role of therapeutic ERCP. Dig Dis Sci. 42(4):865-71, 1997
                                                26. Kirby CL et al: US case of the day. Oriental cholangiohepatitis. Radiographics. 15(6):1503-6, 1995
                                                27. Mack E: Pathogenesis and clinical presentation of bile duct calculi. Semin Laparosc Surg. 2(2):76-84, 1995
                                                28. Reynolds WR et al: Oriental cholangiohepatitis. Mil Med. 159(2):158-60, 1994
                                                29. Enriquez G et al: Intrahepatic biliary stones in children. Pediatr Radiol. 22(4):283-6, 1992
                                                30. Kusano S et al: Oriental cholangiohepatitis: correlation between portal vein occlusion and hepatic atrophy. AJR Am J Roentgenol. 158(5):1011-4, 1992
                                                31. Goldberg HI et al: Diagnostic and interventional procedures for the biliary tract. Curr Opin Radiol. 3(3):453-62, 1991
                                                32. Lim JH: Oriental cholangiohepatitis: pathologic, clinical, and radiologic features. AJR Am J Roentgenol. 157(1):1-8, 1991
                                                33. Lim JH et al: Oriental cholangiohepatitis: sonographic findings in 48 cases. AJR Am J Roentgenol. 155(3):511-4, 1990
                                                34. Schulte SJ et al: CT of the extrahepatic bile ducts: wall thickness and contrast enhancement in normal and abnormal ducts. AJR Am J Roentgenol. 154(1):79-85, 1990
                                                35. Chan FL et al: Evaluation of recurrent pyogenic cholangitis with CT: analysis of 50 patients. Radiology. 170(1 Pt 1):165-9, 1989
                                                36. Kashi H et al: Recurrent pyogenic cholangiohepatitis. Ann R Coll Surg Engl. 71(6):387-9, 1989
                                                37. vanSonnenberg E et al: Oriental cholangiohepatitis: diagnostic imaging and interventional management. AJR Am J Roentgenol. 146(2):327-31, 1986
                                                38. Federle MP et al: Recurrent pyogenic cholangitis in Asian immigrants. Use of ultrasonography, computed tomography, and cholangiography. Radiology. 143(1):151-6, 1982
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Pathology

                                                      • Clinical Issues

                                                        TERMINOLOGY

                                                        • Abbreviations

                                                          • Recurrent pyogenic cholangitis (RPC)

                                                        • Synonyms

                                                          • Oriental cholangitis, oriental cholangiohepatitis, intrahepatic pigment stone disease
                                                          • Biliary obstruction syndrome of Chinese/Hong Kong disease

                                                        • Definitions

                                                          • Disease characterized by formation of pigment stones throughout biliary tree with resultant biliary strictures and repeated bouts of cholangitis

                                                        IMAGING

                                                        • General Features

                                                          • Fluoroscopic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Ultrasonographic Findings

                                                                  • Nuclear Medicine Findings

                                                                    • Other Modality 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. Gupta A et al: Recurrent pyogenic cholangitis. StatPearls, 2021
                                                                                              2. 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
                                                                                              3. Kwan KEL et al: Recurrent pyogenic cholangitis: a review of imaging findings and clinical management. Abdom Radiol (NY). 42(1):46-56, 2017
                                                                                              4. Lee KH et al: The arrowhead appearance of bile ducts in recurrent pyogenic cholangitis. Abdom Radiol (NY). 42(12):2964-5, 2017
                                                                                              5. Furtado R et al: Recurrent pyogenic cholangitis. ANZ J Surg. 85(6):491-2, 2015
                                                                                              6. Katabathina VS et al: Adult bile duct strictures: role of MR imaging and MR cholangiopancreatography in characterization. Radiographics. 34(3):565-86, 2014
                                                                                              7. Tsui WM et al: Hepatolithiasis and the syndrome of recurrent pyogenic cholangitis: clinical, radiologic, and pathologic features. Semin Liver Dis. 31(1):33-48, 2011
                                                                                              8. Tsui WM et al: Primary hepatolithiasis, recurrent pyogenic cholangitis, and oriental cholangiohepatitis: a tale of 3 countries. Adv Anat Pathol. 18(4):318-28, 2011
                                                                                              9. Wani NA et al: MRI of oriental cholangiohepatitis. Clin Radiol. 66(2):158-63, 2011
                                                                                              10. Heffernan EJ et al: Recurrent pyogenic cholangitis: from imaging to intervention. AJR Am J Roentgenol. 192(1):W28-35, 2009
                                                                                              11. Jain M et al: MRCP findings in recurrent pyogenic cholangitis. Eur J Radiol. 66(1):79-83, 2008
                                                                                              12. Menias CO et al: Mimics of cholangiocarcinoma: spectrum of disease. Radiographics. 28(4):1115-29, 2008
                                                                                              13. Kim JH et al: CT findings of cholangiocarcinoma associated with recurrent pyogenic cholangitis. AJR Am J Roentgenol. 187(6):1571-7, 2006
                                                                                              14. Safar F et al: Magnetic resonance T1 gradient-echo imaging in hepatolithiasis. Abdom Imaging. 30(3):297-302, 2005
                                                                                              15. Hanbidge AE et al: From the RSNA refresher courses: imaging evaluation for acute pain in the right upper quadrant. Radiographics. 24(4):1117-35, 2004
                                                                                              16. Lee WJ et al: Radiologic spectrum of cholangiocarcinoma: emphasis on unusual manifestations and differential diagnoses. Radiographics. 21 Spec No:S97-S116, 2001
                                                                                              17. Park MS et al: Recurrent pyogenic cholangitis: comparison between MR cholangiography and direct cholangiography. Radiology. 220(3):677-82, 2001
                                                                                              18. Cosenza CA et al: Current management of recurrent pyogenic cholangitis. Am Surg. 65(10):939-43, 1999
                                                                                              19. Kim MJ et al: MR imaging findings in recurrent pyogenic cholangitis. AJR Am J Roentgenol. 173(6):1545-9, 1999
                                                                                              20. Yoon KH et al: Inflammatory pseudotumor of the liver in patients with recurrent pyogenic cholangitis: CT-histopathologic correlation. Radiology. 211(2):373-9, 1999
                                                                                              21. Harris HW et al: Recurrent pyogenic cholangitis. Am J Surg. 176(1):34-7, 1998
                                                                                              22. Leow CK et al: Re: Biliary access procedure in the management of oriental cholangiohepatitis. Am Surg. 64(1):99, 1998
                                                                                              23. Lee DW et al: Biliary infection. Baillieres Clin Gastroenterol. 11(4):707-24, 1997
                                                                                              24. Lo CM et al: The changing epidemiology of recurrent pyogenic cholangitis. Hong Kong Med J. 3(3):302-4, 1997
                                                                                              25. Sperling RM et al: Recurrent pyogenic cholangitis in Asian immigrants to the United States: natural history and role of therapeutic ERCP. Dig Dis Sci. 42(4):865-71, 1997
                                                                                              26. Kirby CL et al: US case of the day. Oriental cholangiohepatitis. Radiographics. 15(6):1503-6, 1995
                                                                                              27. Mack E: Pathogenesis and clinical presentation of bile duct calculi. Semin Laparosc Surg. 2(2):76-84, 1995
                                                                                              28. Reynolds WR et al: Oriental cholangiohepatitis. Mil Med. 159(2):158-60, 1994
                                                                                              29. Enriquez G et al: Intrahepatic biliary stones in children. Pediatr Radiol. 22(4):283-6, 1992
                                                                                              30. Kusano S et al: Oriental cholangiohepatitis: correlation between portal vein occlusion and hepatic atrophy. AJR Am J Roentgenol. 158(5):1011-4, 1992
                                                                                              31. Goldberg HI et al: Diagnostic and interventional procedures for the biliary tract. Curr Opin Radiol. 3(3):453-62, 1991
                                                                                              32. Lim JH: Oriental cholangiohepatitis: pathologic, clinical, and radiologic features. AJR Am J Roentgenol. 157(1):1-8, 1991
                                                                                              33. Lim JH et al: Oriental cholangiohepatitis: sonographic findings in 48 cases. AJR Am J Roentgenol. 155(3):511-4, 1990
                                                                                              34. Schulte SJ et al: CT of the extrahepatic bile ducts: wall thickness and contrast enhancement in normal and abnormal ducts. AJR Am J Roentgenol. 154(1):79-85, 1990
                                                                                              35. Chan FL et al: Evaluation of recurrent pyogenic cholangitis with CT: analysis of 50 patients. Radiology. 170(1 Pt 1):165-9, 1989
                                                                                              36. Kashi H et al: Recurrent pyogenic cholangiohepatitis. Ann R Coll Surg Engl. 71(6):387-9, 1989
                                                                                              37. vanSonnenberg E et al: Oriental cholangiohepatitis: diagnostic imaging and interventional management. AJR Am J Roentgenol. 146(2):327-31, 1986
                                                                                              38. Federle MP et al: Recurrent pyogenic cholangitis in Asian immigrants. Use of ultrasonography, computed tomography, and cholangiography. Radiology. 143(1):151-6, 1982