Bile duct complications of hepatic arterial infusion chemotherapy evaluated by helical CT

Phongkitkarun, Sith; Kobayashi, Satoshi; Varavithya, Vithya; Huang, Xianbao; Curley, Steven A.; Charnsangavej, C.

doi:10.1016/j.clinimag.2005.07.016

Cited by 6 publications

(11 citation statements)

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“…170,193,[246][247][248][249][250][251][252][253][254][255][256] Sclerosing cholangitislike changes on imaging have been described with chemotherapeutic agents such as 5-fluorodeoxyuridine after hepatic intra-arterial infusions for treatment of hepatic metas- tases. 249,[254][255][256] Cholangiopathy is well documented after abuse of ketamine, both small duct changes and cholangiographic abnormalities. 246,247,256 Secondary sclerosing cholangitis associated with other drugs such as methimazole and docetaxelinduced secondary sclerosing cholangitis have also been reported.…”

Section: Imagingmentioning

confidence: 99%

“…249,[254][255][256] Cholangiopathy is well documented after abuse of ketamine, both small duct changes and cholangiographic abnormalities. 246,247,256 Secondary sclerosing cholangitis associated with other drugs such as methimazole and docetaxelinduced secondary sclerosing cholangitis have also been reported. 248,250 A recent study of cholangiographies performed on unselected patients with DILI suggested that up to 10% of DILI cases may have secondary sclerosing cholangitis-like changes on MRCP.…”

Section: Imagingmentioning

confidence: 99%

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EASL Clinical Practice Guidelines: Drug-induced liver injury

Andrade¹,

Aithal²,

Bjõrnsson³

et al. 2019

Journal of Hepatology

754

394

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Idiosyncratic (unpredictable) drug-induced liver injury is one of the most challenging liver disorders faced by hepatologists, because of the myriad of drugs used in clinical practice, available herbs and dietary supplements with hepatotoxic potential, the ability of the condition to present with a variety of clinical and pathological phenotypes and the current absence of specific biomarkers. This makes the diagnosis of drug-induced liver injury an uncertain process, requiring a high degree of awareness of the condition and the careful exclusion of alternative aetiologies of liver disease. Idiosyncratic hepatotoxicity can be severe, leading to a particularly serious variety of acute liver failure for which no effective therapy has yet been developed. These Clinical Practice Guidelines summarize the available evidence on risk factors, diagnosis, management and risk minimization strategies for drug-induced liver jury.

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Section: Imagingmentioning

confidence: 99%

Section: Imagingmentioning

confidence: 99%

EASL Clinical Practice Guidelines: Drug-induced liver injury

Andrade¹,

Aithal²,

Bjõrnsson³

et al. 2019

Journal of Hepatology

754

394

View full text Add to dashboard Cite

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“…CT and MR can show a similar appearance to primary sclerosing cholangitis, with narrowing of bile ducts. 63,64 Magnetic resonance cholangiopancreatography helps differentiate these two entities by demonstrating primary involvement of bile ducts at the hepatic portal in drug-induced sclerosing cholangitis. 63 Contrast-enhanced CT or MRI can also show periductal edema, enhanced and thickened bile duct wall, and heterogeneous liver enhancement.…”

Section: Computed Tomography and Magnetic Resonance Imagingmentioning

confidence: 99%

Optimizing diagnostic approach to drug-induced liver injury

Minissale¹,

Soresi²,

Galia

et al. 2018

Ital J Med

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Drug-induced liver injury (DILI) is often a trial even to expert clinicians, because sometimes diagnosis is not easy to be made. Guidelines of the American College of Gastroenterology (ACG) yielded in 2014, help to better understand the problem. The diagnosis of DILI is made through a detailed evaluation of clinical, serological, radiological and histological aspects. Biochemical data include liver function tests that allow to assess the pattern of damage, such as hepatocellular, cholestatic and mixed liver injury; serological data include testing for major and possibly minor hepatotropic viruses, non-organ specific autoantibodies. Clinical scenario might include jaundice, nausea, vomiting and extra-hepatic manifestations such as fever, pruritus, rash and eosinophilia. Investigation of the potential culprit drugs should involve firstly the temporal relationship between intake of the medication and onset of symptoms, thus the improvement after drug withdrawal. Overall, to complete the diagnostic evaluation, an abdominal ultrasound can be performed, as well as measurement of liver stiffness by transient elastography, and finally liver biopsy, which still represents the most accurate method to definitely assess liver damage. Sometimes, in such cases, computed tomography scan and magnetic resonance could help in the diagnosis of cases presenting with focal lesions of the liver, with cholestatic-like disease or vascular alterations, such as veno-occlusive disease. DILI diagnostic criteria help clinicians thinking of liver injury induced by drug, excluding other causes of liver disease. According to severity of liver damage and type of drug, it is possible to carefully predict the patient’s outcome.

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“…A form of sclerosing cholangitis may follow transcatheter arterial embolization and intra‐arterial infusion chemotherapy, in particular fluorodeoxyuridine (FUDR) for treatment of liver metastases from colorectal adenocarcinoma 44,45 . The cholangitis was assumed to be caused by the toxic effect of FUDR, but an ischaemic aetiology was later considered 45,46 . Sclerosing cholangitis and intrahepatic or extrahepatic strictures may potentially lead to biliary cirrhosis 46 .…”

Section: Acquired Sclerosing Cholangitismentioning

confidence: 99%

“…The cholangitis was assumed to be caused by the toxic effect of FUDR, but an ischaemic aetiology was later considered 45,46 . Sclerosing cholangitis and intrahepatic or extrahepatic strictures may potentially lead to biliary cirrhosis 46 . Ischaemic cholangitis is also a well‐documented complication of arterial occlusion in the liver allograft, leading to changes that closely resemble those of sclerosing cholangitis 47 .…”

Section: Acquired Sclerosing Cholangitismentioning

confidence: 99%

Inflammatory disease of the bile ducts–cholangiopathies: liver biopsy challenge and clinicopathological correlation

Portmann

Zen

2011

Histopathology

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Liver biopsy challenge and clinicopathological correlation Liver biopsy interpretation in inflammatory diseases of the bile ducts or chronic cholangiopathies may be challenging, especially for pathologists working outside referral centres, where there is a limited exposure to relatively uncommon conditions. In view of the importance of sampling errors resulting from the patchy distribution of pathognomonic bile duct injuries and the misleading absence of cholestasis in the early stages, there is a need to recognize surrogate markers and subtle changes, in particular the early periportal deposition of copper and mild biliary interface activity. Such findings may either constitute the first indication of a primarily biliary disorder or be supportive of a clinically suspected diagnosis. Histological changes common to chronic cholangiopathies are reviewed at the variable stages of development that patients may first present to clinicians. As awareness of the protean clinical manifestations is essential for histological interpretation, the major and distinctive anatomoclinical features of primary biliary cirrhosis and primary and acquired sclerosing cholangitis are revisited, together with so-called overlapping syndromes and less common variants and associations, including more recently documented conditions, such as IgG4-related disease and the rarer multidrug resistance 3 deficiency. The review stresses the importance of evaluating histological changes in conjunction with clinical information.

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Bile duct complications of hepatic arterial infusion chemotherapy evaluated by helical CT

Cited by 6 publications

References 0 publications

EASL Clinical Practice Guidelines: Drug-induced liver injury

EASL Clinical Practice Guidelines: Drug-induced liver injury

Optimizing diagnostic approach to drug-induced liver injury

Inflammatory disease of the bile ducts–cholangiopathies: liver biopsy challenge and clinicopathological correlation

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