Ultrasound of Cholangitis

Cholangitis is an inflammation of the biliary ducts, most commonly secondary to obstruction. It is rarely possible to distinguish cholangitis from simple duct dilatation on ultrasound, although in severe cases the ductal walls appear irregular (Fig. A) and debris can be seen in the larger ducts (Fig. B). 
The walls of the ducts may appear thickened. Care should be taken to differentiate this appearance from tumour invasion and further imaging is often necessary to exclude malignancy. Bacterial cholangitis is the most common form, due to bacterial infection which ascends the biliary tree. Bacterial cholangitis is also associated with biliary enteric anastomoses. It may be complicated by abscesses if the infection is progressive and untreated. Small abscesses may be difficult to diagnose on ultrasound, as they are frequently isoechoic and ill-defined in the early stages and biliary dilatation makes evaluation of the hepatic parenchyma notoriously difficult. Contrast CT will often identify small abscesses not visible on ultrasound, and MRCP or ERCP demonstrates mural changes in the ducts.
Other forms of cholangitis include:
● Primary sclerosing cholangitis, a chronic, progressive cholestatic disease, which exhibits ductal thickening, focal dilatation and strictures
● AIDS-related cholangitis which causes changes similar to that of primary sclerosing cholangitis.
● Recurrent pyogenic cholangitis (Oriental cholangiohepatitis) which is endemic in Southeast Asia and is  ssociated with parasites and malnutrition. Intrahepatic biliary stones are also a feature of this condition.
Fig. B
Ultrasound images Cholangitis
Fig. A
Small stone in the CBD causing intermittent obstruction. ultrasound images of small stone, Cholangitis ultrasound images

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