Differential diagnosis of bile duct injury and ductopenia

Injury and loss of intrahepatic bile ducts are relatively common manifestations of liver disease in both adults and children. They occur in a wide variety of conditions ranging from developmental abnormalities and errors of metabolism to autoimmune disorders, infections, and iatrogenic states. Consequently the differential diagnosis is often complex. Moreover, although duct injury is generally easily detected in needle biopsy specimens, ductopenia is not infrequently both overlooked and overdiagnosed. This article reviews the differential diagnosis of duct injury and ductopenia in liver biopsy specimens and provides an algorithmic framework for narrowing down the differential diagnosis before correlation with the clinical findings.