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Gillian Lieberman, MD
September 2010
Oriental Cholangiohepatitis
(OCH): Radiologic Features
Lee, Ming-Yen,
Kaohsiung Medical University, Year IV
Gillian Lieberman, MD
Lee, Ming-Yen
Gillian Lieberman, MD
Agenda
• Patient presentation
− Initial presentation
− Radiologic findings
• Oriental Cholangiohepatitis
− Pathogenesis
− Differential diagnosis
− Relative Roles of Imaging Tests
− Management
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Lee, Ming-Yen
Gillian Lieberman, MD
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Lee, Ming-Yen
Gillian Lieberman, MD
C-
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BIDMC PACS
Lee, Ming-Yen
Gillian Lieberman, MD
C+ 3mins delay
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BIDMC PACS
Lee, Ming-Yen
Gillian Lieberman, MD
BIDMC PACS
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Lee, Ming-Yen
Gillian Lieberman, MD
Oriental Cholangiohepatitis
Lee, Ming-Yen
Gillian Lieberman, MD
Oriental Cholangiohepatitis
• Oriental cholangiohepatitis (OCH), also known
as
− Oriental cholangitis
− recurrent pyogenic cholangitis
− Intrahepatic pigmented stone disease
• characterized by recurrent attacks of fever,
chills, abdominal pain, and jaundice (Charcot's
triad of acute cholangitis )
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Lee, Ming-Yen
Gillian Lieberman, MD
Oriental Cholangiohepatitis:
pathogenesis
• The bile ducts are markedly abnormal, characterized by
extrahepatic and intrahepatic ductal dilatation with
focal areas of stricturing in the intrahepatic biliary tree.
• The biliary wall is fibrotic with inflammatory cell
infiltration.
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Website: The radiology assistant
Lee, Ming-Yen
Gillian Lieberman, MD
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AJR 157:1-8, July 1991
Lee, Ming-Yen
Gillian Lieberman, MD
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AJR 157:1-8, July 1991
Lee, Ming-Yen
Gillian Lieberman, MD
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AJR 157:1-8, July 1991
Lee, Ming-Yen
Gillian Lieberman, MD
Our patient: comparison OCH on CT
w/o contrast
BIDMC
PACS
• Stones!
Strictures!
Acute tapering!
BIDMC PACS
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Lee, Ming-Yen
Gillian Lieberman, MD
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Website: The radiology assistant
Lee, Ming-Yen
Gillian Lieberman, MD
RadioGraphics
2001; 21:3–22 18
Lee, Ming-Yen
Gillian Lieberman, MD
DDx2: Clonorchiasis on CT
• Clonorchiasis
− diffuse dilatation of the
intrahepatic bile ducts
with no or minimal
dilatation of the large
bile ducts
− Periductal changes are
more severe in
clonorchiasis
− Stones and flukes of C.
sinensis can be
differentiated easily.
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Imaging Tests: us + CT
• Sonography
− the main technique used for screening and
diagnosis in suspected OCH
• CT is not a screening procedure, but it is
recommended when
− sectional imaging is mandatory but
sonography is not confirmative or is
equivocal
− when space-occupying lesions complicate
OCH
− when hepatic resection is planned
− When imaging guidance is needed for
complex drainage procedures
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Gillian Lieberman, MD
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Lee, Ming-Yen
Gillian Lieberman, MD
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Lee, Ming-Yen
Gillian Lieberman, MD
Reference
• Jae Hoon Lim, Oriental Cholangiohepatitis: Pathologic, Clinical, and Radiologic
Features,AJR 157:1-8, July 1991
• Uptodate, Oriental cholangiohepatitis
• Chan F-L, Man S-W, Leong LLY, Fan S-T. Evaluation ofrecurrent pyogenic cholangitis
with CT: analysis of 50 patients. Radiology 1989;170: 165-1 69
• Gillian Lieberman, MD, G. Lieberman’s Primary Care Radiology.
http://eradiology.bidmc.harvard.edu
• Cheng YF; Lee TY; Sheen-Chen SM; Huang TL; Chen TY, Treatment of complicated
hepatolithiasis with intrahepatic biliary stricture by ductal dilatation and stenting:
long-term results, World J Surg 2000 Jun;24(6):712-6.
• Mary Ann Turner, MD, Ann S. Fulcher, MD, The Cystic Duct: Normal Anatomy and
Disease Processes, RadioGraphics 2001; 21:3–22
• Donald W Kufe, MD,Raphael E Pollock, et al. Holland-Frei Cancer Medicine,6th
edition, Section 28: Gastrointestinal Tract, Bile Duct Cancer,
http://www.ncbi.nlm.nih.gov/bookshelf/br.fcgi?book=cmed6
• The radiology assistant, http://www.radiologyassistant.nl, Biliary Ducts : Benign
and Malignant Diseases, Angela D. Levy MDChief Gastrointestinal Radiology,
University Department of Radiologic Pathology, Armed Forces Institute of Pathology,
Washington DC
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Lee, Ming-Yen
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Acknowledgements
• Gillian Lieberman, MD
• Robert Sheiman, MD
• Girish Tyagi, MD
• Leo Tsai, MD, PhD, MSc
• David Glazier, MD
• Elizabeth Asch, MD
• Wabmaster, Larry Barbaras
• Emily Hanson
Acting Medical Student Education Coordinator
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Lee, Ming-Yen
Gillian Lieberman, MD