Ischemic Cholangitis

 Manifestations vary with severity and rapidity of ischemic insult


image Causes include arterial thrombosis, surgical injury, hypotension





Clinical Issues




• Prognosis varies depending on rapidity and extent of ischemic insult
image Severe acute injury may lead to hepatic failure

image Chronic ischemia leads to progressive obliteration of bile ducts, biliary cirrhosis, liver failure


Imaging




• Acute ischemic injury results in dilated bile ducts with filling defects due to biliary casts
• In chronic setting, diffuse stricturing and segmental dilatation of biliary tree seen by CT, MR, MRCP, or ERCP

image Ischemic cholangitis is one cause of secondary sclerosing cholangitis


Microscopic




• Acute ischemia
image Bile duct epithelial cell necrosis and desquamation with formation of biliary casts

image Bile leaks result in bilomas and bile abscess

• Chronic ischemic injury
image Atrophy and erosion of large duct epithelium

image Periductal fibrosis with progressive bile duct loss, stricturing, and fibrosis

image Secondary features of biliary obstruction

image Progression to biliary fibrosis or cirrhosis

image
Bile Duct Epithelial Cell Necrosis
Acute ischemic cholangitis features bile duct epithelial cell necrosis image, as well as sloughing of epithelial cells into the bile duct lumen image to form biliary casts.


image
Biliary Cast
This injured bile duct contains a brightly eosinophilic biliary cast image in a case of acute ischemic cholangitis. There is also mild portal inflammation and periductal edema image .

image
Periductal Fibrosis
The bile duct injury in ischemic cholangitis features uneven nuclear spacing and loss of polarity. There is surrounding periductal fibrosis image .

image
Progressive Bile Duct Loss
Progressive bile duct loss is a feature of chronic ischemic cholangitis. This portal tract contains a hepatic artery image and portal vein image branches but lacks an identifiable bile duct profile.


TERMINOLOGY


Synonyms




• Ischemic cholangiopathy

Apr 20, 2017 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Ischemic Cholangitis
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