Sonographic diagnosis of cholangitis in AIDS patients

Eleven acquired immunodeficiency syndrome (AIDS) patients were initially evaluated by ultrasound of the liver because of biochemical evidence of cholestasis. Sonography was very useful for demonstrating dilatation and/or wall thickening of the common bile duct associated with dilated intrahepatic bile ducts. Periportal hypo- or hyperchoic areas were also visualized. In seven patients, gallbladder walls were thickened. In six patients, the diagnosis of cholangitis was confirmed by endoscopic retrograde cholangiography and/or histology. Cytomegalovirus infection or digestive tract cryptosporidiosis were often present and accounted for diarrhea in most patients. We believe the association of upper right quadrant pain and anicteric cholestasis in the course of AIDS is suggestive of cholangitis, but a disparity may exist between mild symptoms and sonographically demonstrated extensive biliary involvement.