Diagnostic ultrasound ( PDFDrive )

CHAPTER 6 The Biliary Tree and Gallbladder 179
A
B
C
FIG. 6.18 Clonorchis Sinensis Infection. (A) Transverse view
shows a peripherally dilated duct (arrow) with no obstructive
cause seen. A few other dilated peripheral ducts were noted
elsewhere in the liver (not shown). (B) CT image of the same
dilated duct. (C) Transverse image through the right lobe shows
a normal-caliber, central right hepatic duct (arrowhead), a common
inding. The few dilated ducts infer a light infestation.
he imaging of O. felineus infestation has not been systematically
described.
Recurrent Pyogenic Cholangitis
Recurrent pyogenic cholangitis has been known by other names,
including hepatolithiasis and (now obsolete) Oriental cholangiohepatitis.
It is a disease characterized by chronic biliary
obstruction, stasis, and stone formation, leading to recurrent
episodes of acute pyogenic cholangitis. Its incidence is highest
in Southeast and East Asia. It is rare and sporadic in other populations.
Although liver luke infections (especially C. sinensis),
malnutrition, and portal bacteremia have all been implicated,
the cause of recurrent pyogenic cholangitis remains unknown. 36
Any segment of the liver may be afected, but the lateral segment
of the let lobe is most oten involved. Acute complications of
the disease, most importantly sepsis, may be fatal and may need
urgent percutaneous biliary decompression or surgery. he chronic
stasis and inlammation eventually lead to severe atrophy of the
afected segment. Biliary cirrhosis and cholangiocarcinoma are
long-term complications. he treatment of hepatolithiasis lies
in repeated biliary dilation and stone removal. 37
Ultrasound is oten used for both screening and monitoring
of recurrent pyogenic cholangitis. 19 he typical appearance
on sonography is dilated ducts illed with sludge and stones,
conined to one or more segments of the liver (Figs. 6.19 and
6.20). Patients may also have multiple echogenic masses in the
liver, and recognizing that these, in fact, lie within extremely
dilated ducts requires care. When dilated ducts are identiied, their