Diagnostic Ultrasound - Abdomen and Pelvis

Recurrent Pyogenic Cholangitis
(Left) Grayscale ultrasound of
the liver shows echogenic
intrahepatic duct stones ſt
and sludge st within
moderately dilated
intrahepatic biliary ducts.
Note periductal
hyperechogenicity , related
to periductal inflammation in
this patient with RPC. (Right)
Color Doppler ultrasound in
the same patient
demonstrates no flow within
the dilated intrahepatic duct
ſt, confirming the findings are
indeed in the biliary tree
rather than the portal or
hepatic arterial system.
Diagnoses: Biliary System
(Left) Axial noncontrast CT
shows hyperdense stones ſt
filling dilated intrahepatic
ducts predominantly affecting
the left lateral segment of the
liver. Also note mild atrophy of
left lateral segment , often
seen in affected segments of
the liver. (Right) Color Doppler
and grayscale ultrasound of
the liver show a dilated right
intrahepatic duct filled with
hypoechoic material ſt
consistent with intrahepatic
biliary sludge. No color signal
is detectable in the dilated
duct, confirming this is the
biliary system in this patient
with RPC.
(Left) ERCP shows multiple
stones ſt in a dilated common
bile duct (CBD). Upstream
intrahepatic biliary ductal
dilatation with rapid tapering
and decreased arborization st
is characteristic of RPC. Also
notice the left main biliary
duct is "missing" due to
obstruction by an intrahepatic
biliary stone . (Right)
Coronal T2-weighted MR in
the same patient shows
impacted stones ſt in the CBD
and left intrahepatic duct st
with associated biliary ductal
dilatation. Right intrahepatic
ducts are dilated and taper
abruptly .
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