Department of Radiology, Soonchunhyang University Cheonan Hospital, Republic of Korea.
Br J Radiol. 2012 Dec;85(1020):e1219-25. doi: 10.1259/bjr/21182091.
To evaluate the causes of acute cholangitis without biliary dilatation and to compare the clinical characteristics and the imaging findings between patients with acute cholangitis with and without biliary dilatation.
93 patients diagnosed with acute cholangitis underwent contrast-enhanced CT. Among them, 17 patients were classified as not having biliary dilatation (Group 1) and 76 patients were classified as having biliary dilatation (Group 2). The causes of acute cholangitis were evaluated in both groups. Clinical characteristics and imaging findings were compared between the two groups.
The causes of acute cholangitis without biliary dilatation included common bile duct (CBD) stones (n=11), CBD sludge (n=3), a passed stone (n=1) and unknown causes (n=2). The total bilirubin levels of Group 1 were significantly lower than those of Group 2 (p=0.001). By contrast, Group 1 had higher median alanine aminotransferase (ALT) levels than Group 2 (p=0.04). The length of hospital stay was significantly longer in Group 2 than in Group 1 patients (p<0.001). In the imaging findings, the extent of transient hepatic attenuation differences (THADs) (p=0.003) were significantly smaller in Group 1 than in Group 2.
CBD stones and sludge were the most common causes of acute cholangitis in patients without biliary dilatation. These patients showed lower levels of bilirubin and higher levels of ALT than those with acute cholangitis with biliary dilatation, and had a shorter duration of hospital stay. The extent of THADs was the only discriminative CT finding between the two groups.
Acute cholangitis can present without biliary dilatation on imaging, and the most common causes are CBD stones and sludge. The patients with acute cholangitis without biliary dilatation have different clinical characteristics and imaging findings compared with those with acute cholangitis presenting with biliary dilatation.
评估不伴胆管扩张的急性胆管炎的病因，并比较伴或不伴胆管扩张的急性胆管炎患者的临床特征和影像学表现。
对 93 例诊断为急性胆管炎的患者行增强 CT 检查。其中 17 例患者未出现胆管扩张（第 1 组），76 例患者出现胆管扩张（第 2 组）。评估两组患者的急性胆管炎病因。比较两组患者的临床特征和影像学表现。
不伴胆管扩张的急性胆管炎的病因包括胆总管（CBD）结石（n=11）、CBD 泥沙样结石（n=3）、已通过的结石（n=1）和原因不明（n=2）。第 1 组的总胆红素水平明显低于第 2 组（p=0.001）。相比之下，第 1 组的中位丙氨酸氨基转移酶（ALT）水平高于第 2 组（p=0.04）。第 2 组的住院时间明显长于第 1 组（p<0.001）。在影像学表现中，第 1 组的一过性肝衰减差异（THADs）范围明显小于第 2 组（p=0.003）。
CBD 结石和泥沙样结石是不伴胆管扩张的急性胆管炎患者最常见的病因。这些患者的胆红素水平较低，ALT 水平较高，住院时间较短。THADs 的范围是两组之间唯一的鉴别 CT 表现。
影像学上急性胆管炎可不伴胆管扩张，最常见的病因是 CBD 结石和泥沙样结石。与伴有胆管扩张的急性胆管炎患者相比，不伴胆管扩张的急性胆管炎患者具有不同的临床特征和影像学表现。
