Acute cholangitis: CT evaluation.

The CT findings of 23 patients with proven acute ascending cholangitis were retrospectively evaluated. Computed tomography confirmed the clinical diagnosis and detected the site and etiology of the obstructive process in the majority of patients. Biliary dilatation consistent with the clinical suspicion of acute cholangitis was present in 18 patients (78%), the level of the obstruction was detected in 15 patients, and the etiology of the obstructive process was visualized in 14 cases. Five patients presented with air in the biliary tree and three patients had liver abscesses. There was no good correlation established between jaundice, biliary infection, and the presence or degree of biliary dilatation. Biliary obstruction and acute cholangitis can develop before biliary dilatation is detected. In addition, CT showed limitations in establishing the etiology of the obstructive process, particularly in failing to detect 7 of 17 cases of cholesterol biliary stones.