Chronic infections of the biliary system

Abstract

Chronic inflammation of the gallbladder and the biliary tract due to infections are rare, compared to common cholelithiasis and acute biliary inflammation. This group of diseases includes, besides of chronic cholecystitis with cholelithiasis, also chronic gallbladder inflammation without stones, gallbladder hydrops and porcelain gallbladder. The most common form of chronic biliary tract infection is primary sclerosing cholangitis, while infection due to parasites like oriental cholangiohepatitis is very rare in Europe. Using imaging modalities like ultrasonography, computed tomography and magnetic resonance imaging, normally, besides of porcelain gallbladder, only indirect signs of the disease may be documented. However, when i.v. cholangiography, endoscopic-retrograde cholangiography, percutaneous transhepatic cholangiography or MR-cholangiography are performed, depiction, especially of the biliary tree, is feasible. Differentiation of benign stricture and malignant tumor stenosis is problematic unrelated to the imaging modality used. Due to the unspecific signs of the disease, diagnosis may not be made from imaging alone, but a clinical suspicion may be strengthened.