Liver & intrahepatic bile ducts

Biliary tract disease

Cholangitis lenta / sepsis

Editor-in-Chief: Debra L. Zynger, M.D.
Raul S. Gonzalez, M.D.

Last author update: 10 December 2020
Last staff update: 15 July 2022

Copyright: 2002-2024,, Inc.

PubMed Search: Cholangitis lenta OR cholangiolar cholestasis

Raul S. Gonzalez, M.D.
Page views in 2023: 1,845
Page views in 2024 to date: 531
Cite this page: Gonzalez RS. Cholangitis lenta / sepsis. website. Accessed April 14th, 2024.
Definition / general
  • Cholangitis lenta was originally a term referring to a rare clinical form of chronic sepsis (Hum Pathol 1982;13:19)
  • Now typically used by pathologists to refer to microscopic bile ductular cholestasis (Am J Surg Pathol 2017;41:1607), often in the context of sepsis
Essential features
  • Cholangitis lenta currently functions as a synonym for bile ductular cholestasis
  • Ductular reaction with bile ductular cholestasis is concerning (but not specific) for sepsis
  • Additional terms include cholangiolar cholestasis or subacute nonsuppurative cholangitis (Am J Surg Pathol 2017;41:1607)
  • Lenta appears to mean slow
  • Cause of biliary abnormalities in septic patients is complex, likely multifactorial (Crit Care 2012;16:235)
Case reports
Microscopic (histologic) description
  • Dilated, peripherally located bile ductular reaction that contains inspissated bile
  • Other common findings include portal tract inflammation, duct injury, hepatocyte ballooning or necrosis and canalicular cholestasis (Am J Surg Pathol 2017;41:1607)
Microscopic (histologic) images

Contributed by Raul S. Gonzalez, M.D.
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Ductular cholestasis in sepsis

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Ductular cholestasis in cirrhosis

Sample pathology report
  • Liver, biopsy:
    • Biliary pattern injury with ductular reaction, prominent ductular cholestasis and moderate portal inflammation (see comment)
    • Comment: The clinical concern for liver failure is noted. The histologic findings raise the possibility of sepsis, though they are not specific for that diagnosis.
Differential diagnosis
Board review style question #1

A patient presents with jaundice and general malaise. Workup indicates acute liver failure, along with an elevated white blood cell count. Liver biopsy shows the findings in the image above. What is the most likely diagnosis?

  1. Acetaminophen toxicity
  2. Alpha-1 antitrypsin deficiency
  3. Primary biliary cholangitis
  4. Sepsis
Board review style answer #1
Board review style question #2
What is the term typically used by pathologists to refer to bile ductular cholestasis?

  1. Biliary cholangitis
  2. Cholangitis lenta
  3. Fibrosing cholestatic hepatitis
  4. Obstructive cholestasis
Board review style answer #2
B. Cholangitis lenta

Comment Here

Reference: Cholangitis lenta / sepsis
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