• Source of infection is usually bacteria from duodenum, which ascend biliary tree
• Obstruction due to gallstones accounts for 80% of cases
• Other common causes include biliary strictures (benign or malignant), recent intervention, and hepatobiliary surgery
CLINICAL ISSUES
• Treatment with broad spectrum parenteral antibiotics and biliary drainage (usually via ERCP)
• Patients classically present with Charcot triad (pain, fever, jaundice)
(Left) Coronal CECT in a patient with fever and leukocytosis after Whipple procedure shows the common bile duct anastomosed to the Roux limb with thickening and hyperenhancement of the bile duct wall and adjacent free fluid , characteristic of ascending cholangitis.
(Right) Coronal MRCP in a patient with markedly elevated liver function tests and leukocytosis shows intra- and extrahepatic biliary dilatation. Note the relatively low signal pus and infectious debris within the mid and distal common duct .
(Left) Coronal CECT in a patient presenting with fever and hypotension demonstrates thickening and hyperenhancement of a dilated CBD with a small amount of adjacent fluid , suggesting ascending cholangitis.
(Right) Coronal NECT in the same patient demonstrates an obstructing stone as the cause of the patient’s cholangitis.