Case 333: Recurrent Pyogenic Cholangitis (RPC)

Diagnostic Category:

Clinical Presentation:

25 year old man with history of cystic fibrosis presenting with abdominal pain, fever and jaundice.

CT: Hepatolithiasis, bile duct dilatation, THAD

Imaging Findings:

Portal venous phase CT shows significant bile duct dilatation of both lobes due to recurrent pyogenic cholangitis with hepatolithiasis. Calculi are not radioopaque, which makes their detection and therefore the correct diagnosis difficult. Compare to MR, where the calculi are much better shown.

Note hypervascular perfusion anomaly (THAD) of the left lobe on the first image, which is due to the massive bile duct dilatation.

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