The diagnosis can be suspected by imaging, with typical characteristics centering around appearance of the liver, typically with CT, ultrasound or MRI. Traits that raise suspicion for the infection include intra- and extra- hepatic dilatation and strictures with intraductal pigmented stones, usually in the absence of gallstones and with regions of segmental liver atrophy, particularly the lateral aspect of the left hepatic lobe. There is also reduced arborization of peripheral ducts. Approximately 5% of chronic infections go on to develop cholangiocarcinoma. Pathogenic bacteria responsible for the infection include E. coli, Klebsiella, Pseudomonas, and Proteus species. Anaerobes are a less frequent cause, and a culture positive for multiple strains can be common. When related to Clonorchis sinensis, definitive diagnosis is by identification of eggs by microscopic demonstration in faeces or in duodenal aspirate, but other sophisticated methods have been developed, such as ELISA, which has become the most important clinical technique. Diagnosis by detecting DNAs from eggs in faeces are also developed using PCR, real-time PCR, and LAMP, which are highly sensitive and specific.
Recurrent pyogenic cholangitis
Hepatolithiasis
Biliary pseudolithiasis
Cholesterolosis of gallbladder
Fibrocalculous pancreatopathy
Ascending cholangitis
Primary biliary cholangitis
Ischemic hepatitis