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| __NOTOC__ | | __NOTOC__ |
| {{Cholangitis}} | | {{Cholangitis}} |
| {{CMG}}; {{AE}} {{FH}} | | {{CMG}}; {{AE}}{{ADS}} |
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| ==Overview== | | ==Overview== |
| [[Magnetic resonance cholangiopancreatography]] (MRCP) and endoscopic sonography (EUS) are the most sensitive techniques to correctly determine the underlying cause and level of biliary obstruction in patients with acute cholangitis. [[Endoscopic retrograde cholangiopancreatography]] (ERCP) is also considered a gold standard test for biliary obstruction.
| | There are no other imaging findings associated with cholangitis. |
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| ==Other Imaging Findings== | | ==Other Imaging Findings== |
| ===Endoscopic Retrograde Cholangiopancreatography (ERCP)===
| | There are no other imaging findings associated with cholangitis. |
| * It is the best method available as it is both diagnostic and therapeutic.
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| *It involves the use of [[endoscopy]] to pass a small [[cannula]] into the [[bile duct]].
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| **Radiocontrast is then injected to opacify the duct, and X-rays are taken to get a visual impression of the [[biliary system]].
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| *On the endoscopic image of the [[ampulla]], one can sometimes see a protuberant ampulla from an impacted [[gallstone]] in the [[common bile duct]], or the frank extrusion of pus from the common bile duct orifice.<ref name="efg123"> Cholangitis. Wikipedia (2016). https://en.wikipedia.org/wiki/Ascending_cholangitis#Diagnosis Accessed on April 15, 2016</ref>
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| *In case the ERCP is unsuccessful, a [[percutaneous transhepatic cholangiogram]] (PTCA) can be used to allow access to the [[biliary tree]].<ref name="efg123"> Percutaneous transhepatic cholangiography. Wikipedia (2016). https://en.wikipedia.org/wiki/Percutaneous_transhepatic_cholangiography Accessed on April 20, 2016</ref>
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| **The PTCA procedure involves inserting a needle through the skin and placing a thin tube into a [[duct]] in the [[liver]].
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| **Dye is injected through the tube and x-rays are then taken.
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| For diagnostic purposes, ERCP has now generally been replaced by MRCP. ERCP is only used first-line in critically ill patients in whom delay for diagnostic tests is not acceptable; however, if the index of suspicion for cholangitis is high, an ERCP is typically done to achieve drainage of the obstructed common bile duct.<ref name="efg123"> Cholangitis. Wikipedia (2016). https://en.wikipedia.org/wiki/Ascending_cholangitis#Diagnosis Accessed on April 15, 2016</ref>
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| ===Magnetic Resonance Cholangiopancreatography (MRCP)===
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| *Useful in patients with [[postcholecystectomy]] and in patients with non-conclusive ERCP.<ref name="pmid16691174">{{cite journal |vauthors=Gallix BP, Aufort S, Pierredon MA, Garibaldi F, Bruel JM |title=[Acute cholangitis: imaging diagnosis and management] |language=French |journal=J Radiol |volume=87 |issue=4 Pt 2 |pages=430–40 |year=2006 |pmid=16691174 |doi= |url=}}</ref>
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| **This safe and painless test is increasingly used for diagnosis.
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| *The only disadvantage is that smaller stones can be missed on a MRCP.<ref name="efg123"> Cholangitis. Wikipedia (2016). https://en.wikipedia.org/wiki/Ascending_cholangitis#Diagnosis Accessed on April 15, 2016</ref>
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
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