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Chemotherapy-Induced Cholangitis
KEY FACTS
Terminology
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Chemotherapy-induced sclerosing cholangitis (or biliary sclerosis)
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Iatrogenic cholangitis following intraarterial chemotherapy for hepatic malignancies
Imaging
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MR with MRCP is best imaging test
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Segmental strictures of variable length (similar to those seen in primary sclerosing cholangitis)
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Strictures of common hepatic and larger intrahepatic ducts
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Frequently involves common hepatic duct and biliary confluence but not common bile duct
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Ductal abnormalities may include
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Duct wall thickening and luminal narrowing
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Dilation of intrahepatic bile ducts upstream from strictures
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Periductal edema
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Hepatic perfusion abnormalities
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CT or MR may be necessary to differentiate cholangitis from extrinsic duct compression by lymph nodes or tumor
Top Differential Diagnoses
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Primary sclerosing cholangitis
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Autoimmune pancreatitis-cholangitis syndrome
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Extrinsic compression (liver masses)
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Chemical hepatitis
Clinical Issues
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Cholangiographic abnormalities reported in 7-30% of patients undergoing intraarterial chemotherapy
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Severe complications
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Acute or subacute hepatic failure or death
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Treatment
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Immediate cessation of intraarterial floxuridine; surgical or percutaneous drainage of biliary tree; endoscopic balloon dilation of stricture ± stenting
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Axial CT shows a liver metastasis
that is low in attenuation, likely as a result of necrosis. Note the dilated ducts
that resulted from a stricture of the biliary bifurcation and common hepatic duct, also due to chemotherapy.
that is low in attenuation, likely as a result of necrosis. Note the dilated ducts that resulted from a stricture of the biliary bifurcation and common hepatic duct, also due to chemotherapy.
Transhepatic cholangiogram in the same patient shows gross dilation of the intrahepatic ducts
with abrupt, high-grade stenosis at the confluence of the right and left ducts
. This patient had received floxuridine through an hepatic arterial catheter
.
with abrupt, high-grade stenosis at the confluence of the right and left ducts . This patient had received floxuridine through an hepatic arterial catheter .
CT of a patient with carcinoid liver metastases after 8 courses of transcatheter arterial chemoembolization shows irregular right periductal low attenuation
, pneumobilia
, posterior segment atrophy, and ascites
. The appearance is compatible with chemotherapy-induced sclerosing cholangitis.
, pneumobilia , posterior segment atrophy, and ascites . The appearance is compatible with chemotherapy-induced sclerosing cholangitis.
ERCP of the same patient shows a proximal common duct stricture
and irregular, strictured intrahepatic ducts
.
and irregular, strictured intrahepatic ducts .
TERMINOLOGY
Synonyms
-
Chemotherapy-induced sclerosing cholangitis (CISC): Biliary sclerosis
Definitions
-
Iatrogenic cholangitis following intraarterial chemotherapy for hepatic malignancies or metastases
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Complication of hepatic artery infusion pump (HAIP) or transarterial chemoembolization (TACE)
-
IMAGING
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