Biliary Tract Emergencies

Cholelithiasis has a high prevalence in Western populations; therefore careful evaluation of the biliary system is essential in acute patients undergoing abdominal imaging. An estimated 15% of the U.S. population has cholelithiasis, although 80% will remain asymptomatic. The disease burden results in 300,000 cholecystectomies performed annually for biliary colic, cholecystitis, and additional related complications.1 However, biliary pathology is not solely related to cholelithiasis. Additional biliary pathology may result from diverse etiologies with infectious, inflammatory, metabolic, neoplastic, traumatic, and iatrogenic causes. Therefore, appropriate management is not solely limited to cholecystectomy, but instead depends on the specific diagnosis. This article explores the various acute biliary pathologies with which radiologists should be familiar, with a particular emphasis on the clinical features, radiologic appearance, adjunct imaging modalities, and treatment.