KEY FACTS
Terminology
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Inflammation of intra-/extrahepatic bile duct walls due to ductal obstruction and infection
Imaging
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Dilatation of intra- and extrahepatic bile ducts
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In cases of early cholangitis or intermittent common bile duct obstruction, bile ducts may not be dilated
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Circumferential thickening of bile duct wall
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Presence of obstructing choledocholithiasis or obstructing tumor
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Periportal hypo-/hyperechogenicity adjacent to dilated intrahepatic ducts
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Presence of purulent bile/sludge
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Multiple small hepatic cholangitic abscesses
Top Differential Diagnoses
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Cholangiocarcinoma
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Pancreatic ductal carcinoma
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Primary sclerosing cholangitis
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Recurrent pyogenic cholangitis
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Other forms of secondary cholangitis
Pathology
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Pathogenesis
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Stone/stricture → obstruction → bile stasis → increased biliary pressure → infection
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Risk factors
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Choledocholithiasis: Most common
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Biliary stricture, biliary stent, choledochal surgery, recent biliary manipulation, and sphincter of Oddi dysfunction
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Clinical Issues
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Charcot triad: Right upper quadrant pain, fever, jaundice
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Complications: Cholangitic liver abscesses and septicemia, portal vein thrombosis
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Treatment: Antibiotics and biliary decompression
Diagnostic Checklist
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Correlate with clinical and laboratory data to achieve accurate imaging interpretation
Scanning Tips
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Look for distal obstructing lesion as most cases of cholangitis occur in partially obstructed biliary system
with only minimal luminal 
distension.
