%0 Journal Article %T Medical image of the week: ascending cholangitis from biliary obstruction %A Wong C %A William P %A Carr G %J Southwest Journal of Pulmonary and Critical Care %D 2013 %I Arizona Thoracic Society %X A 79 year old man with a history of quadriplegia presented to an outside hospital in septic shock. He was found to have an elevated total bilirubin of 10 mg/dL, direct bilirubin of 7 mg/dL, alkaline phosphatase of 405 U/L, and lipase of 370 U/L. Imaging showed cholelithiasis with likely intra- and extrahepatic biliary duct dilatation. The patient underwent placement of a biliary drain with clinical improvement. Additional imaging was requested prior to endoscopic retrograde cholangiopancreatography (ERCP), but magnetic resonance cholangiopancreatography (MRCP) was unavailable due to metallic implants. Interventional radiology performed a cholangiogram using the biliary drain which confirmed biliary obstruction. ERCP was then performed, with significant biliary sludge found and two stents placed. %K ascending cholangitis %K cholangitis %K biliary obstruction %K gall stone %K endoscopic retrograde cholangiopancreatography %K septic shock %K hypperbilirubinemia %K cholelithiasis %K ERCP %K alkaline phosphatase %U http://www.swjpcc.com/imaging/2013/4/24/medical-image-of-the-week-ascending-cholangitis-from-biliary.html