Biliary Emergencies

  • Yves Menu
  • Julien Cazejust
  • Ana Ruiz
  • Louisa Azizi
  • Lionel Arrivé
Part of the Medical Radiology book series (MEDRAD)


Computed tomography (CT) is an important tool in the workup of patients with biliary emergencies. Optimal settings are mandatory to take full advantage of multidetector CT and to obtain the best multiplanar images with the lowest achievable radiation dose. CT is also part of an imaging strategy together with ultrasonography and magnetic resonance imaging. CT is a problem solver in the case of cholecystitis, most often complementary to ultrasonography, especially in the case of complications such as abscesses. CT is also an important tool to assess unusual diseases such as Mirizzi syndrome and ischemic cholangitis. Because CT is a tool that is available 24/7, the radiologist should be familiarize himself or herself with appropriate protocols and with interpretation of common and/or severe diseases, because most of clinical situations will require urgent medical decisions, mainly based on imaging.


Bile Duct Common Bile Duct Acute Cholecystitis Hepatic Duct Liver Abscess 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Atassi B, Bangash AK, Lewandowski RJ et al (2008) Biliary sequelae following radioembolization with yttrium-90 microspheres. J Vasc Interv Radiol 19:691–697PubMedCrossRefGoogle Scholar
  2. Barie PS, Eachempati SR (2010) Acute acalculous cholecystitis. Gastroenterol Clin North Am 39:343–357PubMedCrossRefGoogle Scholar
  3. Brenner DJ (2010) Should we be concerned about the rapid increase in CT usage? Rev Environ Health 25:63–68PubMedCrossRefGoogle Scholar
  4. Brewer BJ, Golden GT, Hitch DC, Rudolf LE, Wangensteen SL (1976) Abdominal pain. An analysis of 1,000 consecutive cases in a university hospital emergency room. Am J Surg 131:219–223PubMedCrossRefGoogle Scholar
  5. Cerwenka H (2010) Pyogenic liver abscess: differences in etiology and treatment in Southeast Asia and Central Europe. World J Gastroenterol 16:2458–2462PubMedCrossRefGoogle Scholar
  6. Choi JY, Lee JM, Lee JY et al (2007) Assessment of hilar and extrahepatic bile duct cancer using multidetector CT: value of adding multiplanar reformations to standard axial images. Eur Radiol 17:3130–3138PubMedCrossRefGoogle Scholar
  7. Endo Y (2010) A prospective evaluation of emergency department bedside ultrasonography for the detection of acute cholecystitis. Ultrasound Q 26:228Google Scholar
  8. Gallix BP, Aufort S, Pierredon MA, Garibaldi F, Bruel JM (2006) Une angiocholite: comment la reconnaître? Quelles conduites à tenir? J Radiol 87:430–440PubMedCrossRefGoogle Scholar
  9. Heidenhain C, Pratschke J, Puhl G et al (2010) Incidence of and risk factors for ischemic-type biliary lesions following orthotopic liver transplantation. Transpl Int 23:14–22PubMedCrossRefGoogle Scholar
  10. Hubert C, Annet L, van Beers BE, Gigot JF (2010) The “inside approach of the gallbladder” is an alternative to the classic Calot’s triangle dissection for a safe operation in severe cholecystitis. Surg Endosc 24:2626–2632PubMedCrossRefGoogle Scholar
  11. Jeffrey RB Jr, Nino-Murcia M, Ralls PW, Jain KA, Davidson HC (1995) Color Doppler sonography of the cystic artery: comparison of normal controls and patients with acute cholecystitis. J Ultrasound Med 14:33–36PubMedGoogle Scholar
  12. Kimura Y, Takada T, Kawarada Y et al (2007) Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo guidelines. J Hepatobiliary Pancreat Surg 14:15–26PubMedCrossRefGoogle Scholar
  13. Lee JG (2009) Diagnosis and management of acute cholangitis. Nat Rev Gastroenterol Hepatol 6:533–541PubMedCrossRefGoogle Scholar
  14. Lee JH, Lee SR, Lee SY et al (2010) The usefulness of endoscopic ultrasonography in the diagnosis of choledocholithiasis without common bile duct dilatation. Korean J Gastroenterol 56:97–102PubMedCrossRefGoogle Scholar
  15. Mills AM, Baumann BM, Chen EH et al (2010) The impact of crowding on time until abdominal CT interpretation in emergency department patients with acute abdominal pain. Postgrad Med 122:75–81PubMedCrossRefGoogle Scholar
  16. Mirvis SE, Vainright JR, Nelson AW et al (1986) The diagnosis of acute acalculous cholecystitis: a comparison of sonography, scintigraphy, and CT. AJR Am J Roentgenol 147:1171–1175PubMedGoogle Scholar
  17. Neitlich JD, Topazian M, Smith RC, Gupta A, Burrell MI, Rosenfield AT (1997) Detection of choledocholithiasis: comparison of unenhanced helical CT and endoscopic retrograde cholangiopancreatography. Radiology 203:753–757PubMedGoogle Scholar
  18. Parekh J, Corvera CU (2010) Hemorrhagic cholecystitis. Arch Surg 145:202–204PubMedCrossRefGoogle Scholar
  19. Ralls PW, Halls J, Lapin SA, Quinn MF, Morris UL, Boswell W (1982) Prospective evaluation of the sonographic Murphy sign in suspected acute cholecystitis. J Clin Ultrasound 10:113–115PubMedCrossRefGoogle Scholar
  20. Ralls PW, Colletti PM, Lapin SA et al (1985) Real-time sonography in suspected acute cholecystitis. Prospective evaluation of primary and secondary signs. Radiology 155:767–771PubMedGoogle Scholar
  21. Reynolds BM, Dargan EL (1959) Acute obstructive cholangitis; a distinct clinical syndrome. Ann Surg 150:299–303PubMedCrossRefGoogle Scholar
  22. Ripolles T, Ramirez-Fuentes C, Martinez-Perez MJ, Delgado F, Blanc E, Lopez A (2009) Tissue harmonic sonography in the diagnosis of common bile duct stones: a comparison with endoscopic retrograde cholangiography. J Clin Ultrasound 37:501–506PubMedCrossRefGoogle Scholar
  23. Shrikhande S, Friess H, Kleeff J et al (2002) Bile duct infarction following intraarterial hepatic chemotherapy mimicking multiple liver metastasis: report of a case and review of the literature. Dig Dis Sci 47:338–344PubMedCrossRefGoogle Scholar
  24. Solis-Caxaj CA (2009) Mirizzi syndrome: diagnosis, treatment and a plea for a simplified classification. World J Surg 33:1783–1784 (author reply 1786–1787)PubMedCrossRefGoogle Scholar
  25. Soto JA, Alvarez O, Munera F, Velez SM, Valencia J, Ramirez N (2000) Diagnosing bile duct stones: comparison of unenhanced helical CT, oral contrast-enhanced CT cholangiography, and MR cholangiography. AJR Am J Roentgenol 175:1127–1134PubMedGoogle Scholar
  26. Tkacz JN, Anderson SA, Soto J (2009) MR imaging in gastrointestinal emergencies. Radiographics 29:1767–1780PubMedCrossRefGoogle Scholar
  27. Tokunaga Y, Nakayama N, Ishikawa Y et al (1997) Surgical risks of acute cholecystitis in elderly. Hepatogastroenterology 44:671–676PubMedGoogle Scholar
  28. Wagnetz U, Jaskolka J, Yang P, Jhaveri KS (2010) Acute ischemic cholecystitis after transarterial chemoembolization of hepatocellular carcinoma: incidence and clinical outcome. J Comput Assist Tomogr 34:348–353PubMedCrossRefGoogle Scholar
  29. Wu CH, Chen CC, Wang CJ, Wong YC, Wang LJ, Huang CC, Lo WC, Chen HW et al (2010a) Discrimination of gangrenous from uncomplicated acute cholecystitis: accuracy of CT findings. Abdom Imaging. doi: 10.1007/s00261-010-9612-x
  30. Wu JM, Lee CY, Wu YM (2010b) Emphysematous cholecystitis. Am J Surg 200:e53–e54PubMedCrossRefGoogle Scholar
  31. Yie M et al (2010) Diagnostic value of CT features of the gallbladder in the prediction of gallstone pancreatitis. Eur J Radiol. doi: 10.1016/j.ejrad.2010.05.022
  32. Yun EJ, Choi CS, Yoon DY et al (2009) Combination of magnetic resonance cholangiopancreatography and computed tomography for preoperative diagnosis of the Mirizzi syndrome. J Comput Assist Tomogr 33:636–640PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  • Yves Menu
    • 1
  • Julien Cazejust
    • 1
  • Ana Ruiz
    • 1
  • Louisa Azizi
    • 1
  • Lionel Arrivé
    • 1
  1. 1.Hôpital Saint AntoineParisFrance

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