Acalculous inflammatory biliary disease has been reported in patients with acquired immune deficiency syndrome (AIDS). AIDS-related cholangitis manifests the intrahepatic and extrahepatic biliary changes seen in sclerosing cholangitis, including strictures, dilatation, and decreased arborization. Biliary scanning was used to evaluate a patient with suspected AIDS-related cholangitis. The hepatobiliary images showed prompt hepatic uptake, with nonvisualization of the gallbladder, common bile duct, and bowel at two hours. Thus, the overall hepatic clearance time approached infinity. There was also a central photopenic region at the porta hepatis. ERCP confirmed the diagnosis of AIDS-related cholangitis. Infection with cytomegalovirus is the proposed etiology. AIDS-related cholangitis should be included in the differential diagnosis of an obstructive cholescintigraphic pattern.
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