Qap (Anatomical Pathology) 

QAP Peer Review

AP324
Case History: F/40. Recurrent fever and RUQ pain. Right hemihepatectomy
Intended diagnosis: Caroli's disease complicated by acute-on-chronic cholangitis and intrahepatic stones. Contributed by:MST
Code Diagnosis Comment Score
anonymous Recurrent pyogenic cholangitis (100%) nil  90
anonymous Cholangitis,intrahepatic biliary stone, cannot rule out IgG4-associated sclerosing cholangitis nil  90
anonymous 1. Recurrent pyogenic cholangitis (60%) 2. Caroli disease (40%) Need to correlate with gross and radiological findings. If saccular dilatations of the intrahepatic bile ducts are noted, the diagnosis will favour Caroli disease.  100
anonymous Cholangitis with cholesterol in bile ducts suggestive of hepatolithiasis / recurrent pyogenic cholangitis  90
anonymous Recurrent pyogenic cholangitis with abscess formation and foreign body reaction. Special stain and culture for microorganisms eg. ZN for TB and grocott for fungi. Also serology for toxoplasmosis etc.  90
anonymous Caroli disease vs Recurrent pyogenic cholangititis (primary hepatolithiasis) It is in favor of Caroli disease because of right lobe involvement, discrete and marked dilatations of bile ducts, and absence of intrahepatic bilirubin carbinate stones.  100
anonymous Recurrent Pyogenic Cholangitis 100% nil  90
anonymous Recurrent Pyogenic Cholangitis nil  90
anonymous obstructive cholangitis nil  50
anonymous Acute on chronic Cholangitis (recurrent Cholangitis) with ductal dilatation and presence of Intraductal impactation biliary concretion (Intrahepatic stone?). nil  90
anonymous LIVER, right hemihepatectomy - Acute and chronic CHOLANGITIS, differential diagnoses include ductal plate malformation, in particular Caroli's disease (75%) and recurrent pyogenic cholangitis (25%). Please correlate with gross findings. nil  100
anonymous Caroli disease nil  100
anonymous Recurrent pyogenic cholangitis. (100%) nil  90
anonymous cholangitis with biliary stone, suggestive of recurrent pyogenic cholangitis in this clinical context (100%) nil  90
anonymous Liver - Recurrent pyogenic cholangitis with focal mild dysplasia of the biliary ductal epithelium, need to exclude IgG4-related disease by performing immunohistochemistry of IgG and IgG4 (100% probability) nil  90
anonymous Recurrent pygenic cholangitis nil  90
anonymous Primary sclerosing cholangitis 100% nil  50
anonymous Recurrent pyogenic cholangitis. nil  90