Author's Name :
Article Title : MR Cholangiopancreatographic Demonstration of Biliary Tract Abnormalities in AIDS Cholangiopathy: Report of Two Cases.
Journal Name :
1) Bibliography
Vermani, N., Kang, M., Khandelwal, N., Singh, P., & Chawla, Y. K.
(2009). MR cholangiopancreatographic demonstration of biliary tract
abnormalities in AIDS cholangiopathy: report of two cases. Clinical
Radiology, 64(3), 335–338.
https://doi.org/10.1016/j.crad.2008.09.002
2) Purpose of the Article
The purpose of this article was to review two different situations in two patients that having the same disease of AIDS Cholangiopathy. Both cases were distinguished using magnetic resonance cholangio-pancreatography (MRCP) modality. Those images produced purposely to see the changes and defects in the biliary tract.
3) Brief Description of Procedure and Findings/Results
In the first case, a patients presented with right upper abdominal pain and jaundice was assessed. Initially, two serological test was conducted to confirm the seropositivity of HIV. The result of those tests showed increases in certain levels such as bilirubin and alkaline phosphate. The elevation in bilirubin an alkaline phosphate levels were considered as an abnormality to the gallbladder, liver or even bone. Next, an examination of ultrasound was done; there was a mild dilatation of the common bile duct (CBD) illustrated. Similarly, there was an evidence of narrowing appearance at 1.2 cm distally of the CBD. In this case, an MRCP was done by a 1.5 T magnetic resonance imaging (MRI) system of 40 mm sectional thickness with the help of maximum intensity projection (MIP) for a better demonstration of the defection.
For the second case, it involved a 37 years old man with jaundice and hepatomegaly. As similar to the first case, there was also an increment in the alkaline phosphate levels to show distortion to the biliary system. The man had undergone three different test to validate whether his HIV is positive. As ultrasound examination was carried out, an appearance of hepatomegaly with acute acalculous cholecystitis and dilated CBD were indicated. After two days of sonographic procedure, an MRCP was done by using exactly the same sequence pulse as in the first case. It demonstrated dilatation to the CBD that has smooth tapering at the distal part. with smooth tapering in its distal part. As an improvement to the image, multsection axial views were obtained; bulky papilla in duodenum, beaded appearance of biliary ducts and thickening of gall bladder wall were denoted.
4) Conclusions and Comments
To summarize, AIDS patients usually develop the condition of biliary abnormalities. Throughout this article, it was emphasized truthfully that this related pathology can be recognized by using MRCP modality. In addition, it was also mentioned that MRCP is a technique that is safe and non-invasive to best rule out AIDS cholangiopathy.
5) Opinion of the Article
In my opinion, I believed that this article is very helpful in explaining AIDS cholangiopathy disease in total. First thing first, it had described briefly about the incidences of AIDS cholangio-pathy, in which it was evolved few years back. Next, this article has clarified two cases of the same disease using MRCP; final result demonstrated the same appearance to the images. Lastly, in the discussion part was clearly delineated about the nature of AIDS cholangiopathy.
APPEARANCE OF PATHOLOGY ON RADIOGRAPHS/IMAGES
Figure 1: In the first case; (a) MIP image shows smooth narrowing involving the distal part of CBD with upstream dilatation of the proximal duct (arrow). (b) SSFSE RARE MRCP image shows focal dilatations and strictures of intrahepatic biliary ducts.
Figure 2: In the second case; (a) Axial HASTE MRI image reveals bulky papilla bulging into the duodenal lumen. (b) SSFSE RARE image shows narrowing of terminal CBD (arrow) and focal dilatations involving segmental biliary ducts.
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