Sonography in AIDS-related cholangitis: prevalence and cause of an echogenic nodule in the distal end of the common bile duct.

OBJECTIVE

The purpose of this study was to determine the prevalence and cause of an echogenic nodule in the distal end of the common bile duct seen on sonograms in patients who have AIDS-related cholangitis.

SUBJECTS AND

METHODS

Sonograms of the liver and bile ducts were obtained in 15 patients who had AIDS-related cholangitis. Both 3.75- and 5-MHz transducers were used in all patients. The appearance of an echogenic nodule in the distal end of the common bile duct was compared with the results of endoscopic retrograde cholangiograms in 12 patients and with biopsies of the papilla of Vater in the first five cases.

RESULTS

Sonograms showed a hyperechoic nodule in the distal end of the common bile duct in 10 of the 15 cases. Visualization was improved after oral administration of water. The finding correlated with edema of the papilla of Vater noted on retrograde cholangiograms in eight cases. Biopsy of the papilla of Vater in five cases showed an inflammatory infiltrate. The nodule became smaller in one patient when cholestasis improved after treatment for cryptosporidiosis.

CONCLUSION

An echogenic nodule was detected in the distal end of the common bile duct on sonograms in two thirds of patients who had AIDS-related cholangitis. Our findings suggest the abnormality is caused by edema of the papilla of Vater.