Ascending cholangitis ultrasound
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anila Hussain, MD [2]
Overview
A transabdominal ultrasound is the initial test of choice in patients with suspicion of ascending cholangitis to detect common bile duct stones or dilatation[1]. USG is both sensitive and specific in detecting bile duct dilatation yet has a lower sensitivity for detecting bile duct stones. However, bile duct dilatation is not always seen in initial stages of bile duct obstruction making it less reliable[2]. The main finding of ascending cholangitis on an ultrasound is the thickening of the bile duct walls
Ultrasound
A transabdominal ultrasound is the initial test of choice in patients with suspicion of ascending cholangitis to detect common bile duct stones or dilatation[1]. USG is both sensitive and specific in detecting bile duct dilatation yet has a lower sensitivity for detecting bile duct stones. However, bile duct dilatation is not always seen in initial stages of bile duct obstruction making it less reliable[2]. The main finding of ascending cholangitis on an ultrasound is the thickening of the bile duct walls.
There are both Pros and Cons of using ultrasound as a diagnostic modality in ascending cholangitis and are mentioned below;
PROS
- Non-Invasive
- Can be performed at bedside on critical patients in ED
- Sensitive and Specific for bile duct dilatation[3]
- Can help differentiate intra-hepatic disease from extra-hepatic disease[4]
- Can help distinguish between cholangitis and cholecystitis (inflammation of the gallbladder), which has similar symptoms to cholangitis, but appears differently on ultrasound
- Can identify other complications like abscess or empyema
CONS
- Operator dependent
- Unreliable as bile duct dilatation is not seen in initial stages of the disease
- Low sensitivity for detecting common bile duct stones and stones father down the duct
Endoscopic ultrasound (EUS) can be performed in patients who cannot undergo MRCP and are at high risk of complications from ERCP as it is less expensive than MRCP and low rate of complications as compared to ERCP.
References
- ↑ 1.0 1.1 Kinney TP (2007). "Management of ascending cholangitis". Gastrointest Endosc Clin N Am. 17 (2): 289–306, vi. doi:10.1016/j.giec.2007.03.006. PMID 17556149.
- ↑ 2.0 2.1 Gallix BP, Aufort S, Pierredon MA, Garibaldi F, Bruel JM (2006). "[Acute cholangitis: imaging diagnosis and management]". J Radiol. 87 (4 Pt 2): 430–40. PMID 16691174.
- ↑ Hanbidge AE, Buckler PM, O'Malley ME, Wilson SR (2004). "From the RSNA refresher courses: imaging evaluation for acute pain in the right upper quadrant". Radiographics. 24 (4): 1117–35. doi:10.1148/rg.244035149. PMID 15256633.
- ↑ Salem S, Vas W (1981). "Ultrasonography in evaluation of the jaundiced patient". J Can Assoc Radiol. 32 (1): 30–4. PMID 7217163.