KEY FACTS
Terminology
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Secondary sclerosing cholangitis usually resulting from opportunistic infection of biliary tract in AIDS patients with CD4 count < 100/mm³
Imaging
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Knowledge of HIV/AIDS status is key
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Intra- and extrahepatic bile duct strictures
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Thickened, edematous bile ducts
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Dilated common bile duct from papillary stenosis
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Combination of sclerosing cholangitis and papillary stenosis are unique to AIDS cholangiopathy
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Diffuse gallbladder wall thickening without gallstones
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Ultrasound usually followed by ERCP when tissue can be obtained for culture and therapeutic procedures, such as drainage, can be performed
Top Differential Diagnoses
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Primary sclerosing cholangitis
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Autoimmune cholangitis
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Ascending cholangitis
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Cholangiocarcinoma
Pathology
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Chronic inflammation of biliary tract from opportunistic pathogens
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Most common pathogens: Cryptosporidium, CMV
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Favors larger bile ducts
Clinical Issues
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Epigastric/right upper quadrant, diarrhea
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Fever and jaundice, less common
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Liver function tests may be abnormal
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Decreasing prevalence with improved therapy/prophylaxis of patient with HIV infection
Scanning Tips
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Use high-resolution transducer to look for bile duct wall thickening and gallbladder thickening
