Gallbladder and bile duct abnormalities in AIDS: sonographic findings in eight patients

Gallbladder and biliary tract abnormalities were observed on sonography in eight patients with AIDS. The studies were obtained to evaluate right upper quadrant pain (two patients), tenderness (three patients), and abnormal liver function tests (eight patients). The two major sonographic findings were gallbladder wall thickening (eight patients), which often was marked, and bile duct dilatation (two patients). Gallbladder wall thickness varied from 4 to 15 mm and was greater than 1 cm in four patients. Follow-up sonograms in five patients showed increasing wall thickness in four and decreasing thickness in one, but these findings did not correlate well with the clinical status of the patient. Pericholecystic fluid was shown in three cases. None of the patients had gallstones. Common bile duct dilatation varied from 12 to 15 mm; no specific cause for dilatation was found by cholangiography. Mycobacterium avium intracellulare was recovered from the gallbladder in one patient, and Cryptosporidium was recovered from the duodenum in two patients. AIDS should be considered in the differential diagnosis of gallbladder wall thickening or bile duct dilatation in the appropriate clinical setting. These findings may indicate opportunistic infection of the biliary tract. A disparity may exist between the mild symptoms and signs (or lack of symptoms and signs) related to the gallbladder and bile ducts and the sometimes marked sonographic abnormalities.