E1547. Spectrum of Intraluminal Biliary Pathology: Imaging Appearances and Clinical Implications
  1. Christopher Buros; University of Pittsburgh Medical Center
  2. Alessandro Furlan; University of Pittsburgh Medical Center
  3. Biatta Sholosh; University of Pittsburgh Medical Center
  4. Ekta Maheshwari; University of Pittsburgh Medical Center
  5. Venkata Katabathina; University of Texas Health Sciences
  6. Srinivasa Prasad; MD Anderson Cancer Center
  7. Anil Dasyam; University of Pittsburgh Medical Center
A multitude of pathologies affect biliary tree, among which those limited to biliary lumen present unique challenges and opportunities for radiologists. An awareness of these pathological entities and corresponding typical and atypical imaging appearances can help radiologists arrive at appropriate diagnosis and recognize clinically relevant complications.

Educational Goals / Teaching Points
Aim of this exhibit is to review the spectrum of abnormal contents and lesions in biliary ductal lumen including those that form intrinsically within the duct or originate from biliary wall as well as intraluminal extension of extraneous entities. We discuss the role of major imaging modalities such as ultrasound CT, MRI/MRCP, EUS and ERCP in evaluating bile ducts and various pathological processes leading to the abnormal intraluminal contents. We also discuss clinical implications of altered biliary ductal luminal environment.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We present a brief review of normal biliary ductal anatomy and histology, major anatomical aberrations of the biliary tree and how they affect the normal biliary flow. We review the spectrum of intraluminal biliary pathology supported by well-illustrated examples. Abnormal contents forming intrinsically in the lumen of the bile ducts can be varied and include sludge, calculi, casts, mucin, pus, Biliary intraepithelial neoplasia, mural nodules in intraductal papillary mucinous neoplasms of bile duct, malignancies such as polypoid cholangiocarcinoma and biliary neuroendocrine tumor. Extraneous elements can sometimes gain access to the biliary ductal lumen. Gas, hemobilia, migrated surgical clips/stents, reflux of enteric contents, parasites (echinococcus, ascariasis), direct invasion by adjacent malignancies and metastases. Short term and long-term Clinical consequences of the abnormal intraluminal biliary contents will be discussed.

Most common filling defects are sludge and calculi. They can either be manifestation of an underlying disease or lead to complications. Less commonly, several additional non-neoplastic and neoplastic biliary filling defects can be seen. Awareness of their variable imaging features is crucial for prompt diagnosis and early recognition of complications.