Diagnostic Ultrasound - Abdomen and Pelvis

AIDS-Related Cholangiopathy
Diagnoses: Biliary System
TERMINOLOGY
• Secondary sclerosing cholangitis usually resulting from
opportunistic infection of biliary tract in AIDS patients with
CD4 count < 100/mm³
IMAGING
• AIDS patient with papillary stenosis, intrahepatic strictures,
thickened bile ducts and gallbladder (GB) walls
• Normal US essentially rules out diagnosis
• Combination of sclerosing cholangitis and papillary stenosis
are unique to AIDS cholangiopathy
TOP DIFFERENTIAL DIAGNOSES
• Primary sclerosing cholangitis
• Autoimmune cholangitis
• Ascending cholangitis
• Cholangiocarcinoma
KEY FACTS
PATHOLOGY
• Chronic inflammation of biliary tract from opportunistic
pathogens
• Most common pathogens: Cryptosporidium, CMV
CLINICAL ISSUES
• Epigastric/RUQ pain, diarrhea
• Fever and jaundice, less common
DIAGNOSTIC CHECKLIST
• Late-stage AIDS patient (CD4 < 100/mm³)
• Papillary stenosis, intrahepatic strictures, or acalculous
cholecystitis
(Left) Graphic of AIDS-related
cholangiopathy shows
multiple segments of biliary
wall thickening with stenosis
involving both the intrahepatic
and extrahepatic bile ducts.
Also note gallbladder wall
thickening. (Right) Ultrasound
of the porta hepatis shows
mild wall thickening of the
dilated common bile duct
(CBD) ſt, with abrupt
tapering distally . (Courtesy
American Institute for
Radiologic Pathology archives,
case ID# 2447987, US2.)
(Left) Longitudinal ultrasound
through the right lobe shows
dilated intrahepatic ducts with
wall thickening . (Courtesy
American Institute for
Radiologic Pathology archives,
case ID# 2383220, US1.)
(Right) Transverse ultrasound
through the gallbladder shows
mild circumferential wall
thickening ſt without visible
stones. (Courtesy American
Institute for Radiologic
Pathology archives, case ID#
2383220, US3.)
346