Cholangitis and abscess formation in a patient with cholangiocarcinoma

Case contributed by Dr Saeed Soltany Hosn


A 65 years old man came to the emergency departement with severe abdominal pain, chills and fever. Previous medical history was unremarkable

Patient Data

Age: 65-year
Gender: Male

CT scan demonstrates a cystic lesion with heterogeneous density in the inferior margin of the left hepatic lobe associated with dilatation of the intra hepatic biliary ducts and pneumobilia in this lobe. Proximal part of the CBD is also dilated. There are also thickening of the bile ducts wall in the central region of the liver, thrombosis of the left branch of the portal vein and ascites. In addition there is an ill-defined hypodense region in the porta hepatis which causes encasement of the bile ducts and associated with multiple abnormal lymph nodes. There are bilateral pleural effusions and associated with subsegmental collapse of the lower lobe of the left lung as well. Cholecystectomy.

Case Discussion

The findings are consistent with suppurative cholangitis. The patient was placed on appropriate antibiotics which seemed to settle his symptoms and after underwent ERCP and biopsy. Histopathology revealed cholangiocarcinoma.

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