Ascending Cholangitis

1. Pathogenesis:

• Bacterial infection (usually by Gram-negative rods) of the biliary tract.
   
• Often seen in patients with bile duct obstruction.
   
• Presents with abdominal pain, fever, and obstructive Liver Function Tests (LFTs).

2. Radiographic findings:

• Early Findings: none except for obstruction.
   
• Late Findings: pleating or wall irregularity; mural necrosis; intrahepatic abscesses at duct ends.


Typical appearance of bacterial
cholangitis on ERCP.

• Figures: (A) Operative cholangiogram. 29 y.o. female with common biliary duct stones (arrows) and liver abscess (arrowheads). (B) Percutaneous transhepatic cholangiogram. Pancreatic carcinoma obstructing common biliary duct and leading to hepatic abscesses, appearing as rounded collections of contrast agent in dome of liver (arrows).
   

             
A                                                                                                                 B