Case 333: Recurrent Pyogenic Cholangitis (RPC)
25 year old man with history of cystic fibrosis presenting with abdominal pain, fever and jaundice.
T2w MR and MRCP show typical findings of recurrent pyogenic cholangitis: significantly dilated bilobar bile ducts due to obliterating hepatolithiasis and parenchymal volume loss with retraction of hepatic capsule of the left lobe anteriorly due to chronicity of bile duct dilatation. Note that calculi are located mainly in the central portions of the ducts.
ERCP performed three days later correlates well with findings on MR; ductal brushings confirmed absence of malignancy. Patients with RPC are at increased risk for cholangiocarcinoma.