Ascending cholangitis

What is ascending cholangitis, and what are its CT and MR imaging features?

Ascending cholangitis is a biliary bacterial infection that occurs in the setting of bile duct obstruction, most often secondary to common bile duct calculi. Charcot’s triad of right upper quadrant abdominal pain, fever, and jaundice is characteristic but not seen in all patients. Treatment generally involves biliary decompression along with antimicrobial therapy.

CT and MRI findings include bile duct dilation; an underlying obstructive biliary lesion; bile duct wall thickening and hyperenhancement; periductal edema or transient late arterial phase hyperenhancement; pneumobilia; portal vein thrombosis; hepatic biloma or abscess formation; and bile peritonitis


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