Ascending cholangitis

Case contributed by Dr Henry Knipe


Right upper quadrant adominal pain and acute renal failure.

Patient Data

Age: 65 years
Gender: Female

Partly calcified gallstone at the neck of the gallbladder. No pericholecystic fluid or fat stranding.

Gallbladder wall is difficult to appreciate but may be mildly thickened.

High density within a grossly dilated common bile duct is highly suspicious for choledocholithiasis.

Gas is present within the liver within portal vein branches and there is a small locule of gas within the superior mesenteric vein with more substantial volume of gas within tributaries from the mid to distal stomach.

Bowel resection noted with rectosigmoid anastomotic sutures. 3 cm right basal pulmonary mass. In the pelvis, there are loops of small bowel with fecal material mimicking mural gas - note no mural thickening, adjacent fat stranding or free fluid. 

Case Discussion

Acute cholangitis is essentially a clinical diagnosis. Imaging is useful to assess for biliary tree dilatation, possible causes as well as complications. The patient proceeded to ERCP which confirmed choledocholithiasis and ascending cholangitis; it also allowed for biliary decompression.

Portal venous gas can be associated with severe abdominal sepsis such as cholangitis.

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Case information

rID: 39068
Published: 18th Aug 2015
Last edited: 30th Oct 2020
Inclusion in quiz mode: Included

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