Clinics and Research in Hepatology and Gastroenterology (2012) 36, 515—516

Available online at

www.sciencedirect.com

IMAGE OF THE MONTH

MRI features of oriental cholangiohepatitis

Deepak Garg, Mudit Gupta ∗

Department of Radiodiagnosis, Kailash Hospital, Sector-27, Noida, U.P., India

Available online 24 August 2012

A 67-year-old male patient presented with recurrentright upper quadrant abdominal pain, low grade feverand jaundice. Ultrasound of the abdomen was performedwhich demonstrated dilated common bile duct (CBD) andintrahepatic biliary radicles. Magnetic resonance cholan-giopancreatography (Fig. 1a) was performed which revealeddilated common bile duct and asymmetric dilatation of bil-iary radicles. There was cast like filling defects within theproximal CBD, common hepatic duct, right and left hepaticducts and bilateral segmental intrahepatic biliary channels.Segmental atrophy of lateral segments of left hepatic lobe(Fig. 1b) was also visualized. These MR features are charac-teristic of intrahepatic lithiasis. Multiple intrahepatic stonesare commonly observed in oriental cholangiohepatitis [1]but also in other rare diseases, such as severe forms ofABCB4 deficiency-associated cholangiopathy [2] and scleros-ing cholangitis, caroli disease and biliary strictures.

∗ Corresponding author. Tel.: +91 9910876188.E-mail address: drmuditgupta@yahoo.co.in (M. Gupta).

2210-7401/$ – see front matter © 2012 Elsevier Masson SAS. All rights rehttp://dx.doi.org/10.1016/j.clinre.2012.06.003

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Figure 1 a: magnetic resonance cholangiopancreaticog-aphy (MRCP) image demonstrates cast like filling defectwhite arrows) within CBD and intrahepatic biliary radicles

ith dilated biliary channels; b: axial T1 weighted imageemonstrates dilated left segmental biliary ducts with seg-ental atrophy (black arrow) of lateral segment of left

epatic lobe.

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D. Garg, M. Gupta

Oriental cholangiohepatitis, also known as recurrent pyo-enic cholangitis is an endemic disease in South East Asia. Its caused by chronic recurrent infestation of biliary channelsy bacteria. It leads to biliary strictures and dilatations. Bil-ary channels are filled with pigment stone and pus. Thereay be segmental atrophy of liver secondary to chronic bil-

ary obstruction. All these changes are well visualized on MRIs in our case. Complications of this condition are sepsis,iliary leaks, portal hypertension, cirrhosis and cholangio-arcinoma. Management of this condition involves clearancef stones and pus from biliary system as well as managementf complications.

isclosure of interest

he authors declare that they have no conflicts of interestoncerning this article.

eferences

1] Wani NA, et al. MRI of oriental cholangiohepatitis. Clin Radiol

2011;66(2):158—63.

2] Poupon R, et al. The cholangiographic features of severe formsof ABCB4/MDR3 deficiency-associated cholangiopathy in adults.Gastroenterol Clin Biol 2010;34:380—7.