Biliary System

A wide variety of organisms can cause cholecystitis in AIDS, including Microsporidia, Enterocytozoon bieneusi, Septata intestinalis, cytomegalovirus, Cryptosporidium, Pneumocystis carinii, and Isospora belli. AIDS-related cholangitis may produce an echogenic nodule at the distal end of the common bile duct, thought to represent edema of the ampulla of Vater. AIDS-related cholangiopathy may be due to cryptosporidiosis or cytomegalovirus infection. Patients present with right upper quadrant pain, nausea, vomiting, fever, and cholestasis.

On cholangiography, the appearance of AIDS cholangitis is similar to that of sclerosing cholangitis, with diffuse tapered narrowing of the intrahepatic biliary tree (Fig. 8.57A). There may be focal stricturing or beading of the biliary tree (Fig. 8.57B), focal areas of intrahepatic ductal dilatation (Fig, 8.57C), or thickening of the ductal walls or the gallbladder wall. The extrahepatic bile duct may be dilated and thickened but is generally not stenotic (Fig. 8.57D). Papillary stenosis may, however, be present, with dilatation to the level of the papilla.

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Fig. 8.57 A-D. AIDS-related cholangitis causes a variety of changes. (A) Multiple irregular areas of tapered narrowing of the biliary tract are seen on a T-tube cholangiogram. (B) Strictures and areas of dilatation, producing a beaded appearance on T-tube cholangiography. (C) CT scan shows dilatation of portions of the bilary system (arrows) but without ductal dilatation in this patient. (D) Ultrasonography shows thickening of the wall of the common bile duct (arrow). (Courtesy of Dr. William Brandt).

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