Published in:
01-12-2017 | Classics in Abdominal Imaging
The arrowhead appearance of bile ducts in recurrent pyogenic cholangitis
Published in: Abdominal Radiology | Issue 12/2017
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The decreased branching and abrupt tapering of peripheral bile ducts in recurrent pyogenic cholangitis, also known as oriental cholangiohepatitis and Hong Kong disease, produce the classic arrowhead appearance [1, 2] (Figs. 1, 2). Recurrent pyogenic cholangitis, usually found in Southeast Asia and Asian immigrants in Western countries, is an inflammatory disease characterized by repeated bouts of biliary tract infection, intraductal stone formation, and multiple biliary strictures. Chronic inflammation and fibrosis of portal tracts results in destruction and loss of elasticity of the ducts. Its association with Clonorchis sinensis and Ascariasis lumbricoides infestation has been suggested [2].
Fig. 1
A signpost with multiple arrowheads
Fig. 2
Anteroposterior ERCP image showing dilatation of the common bile duct and left lateral segmental ducts with rapid peripheral tapering and reduced arborization. This results in the characteristic arrowhead appearance of bile ducts (arrows)
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