Acute cholangiohepatitis is a severe ascending infection in an obstructed biliary tree. It needs to be distinguished from the more common extrahepatic suppurative cholangitis. Hepatocellular necrosis is a key feature.
Clinical features:
(1) obstruction of the extrahepatic bile duct, often due to lithiasis
(2) acute course with high morbidity and mortality if therapy is delayed
(3) fever
(4) jaundice
(5) right upper quadrant pain
Imaging findings:
(1) dilation and/or strictures of the intrahepatic biliary tree
(2) thickening of bile duct walls
(3) MRI shows several focal T2 weighted hyperintense and T1-weight hypointense lesions lined up along the intrahepatic biliary tree
Histologic findings on liver biopsy:
(1) acute inflammation with cholangioles within the portal triads
(2) periductal microabscesses
(3) patchy periportal hepatocellular necrosis
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