 So here we have a 60 year old patient with elevated liver function tests and MRI was obtained to evaluate the ideology of these findings. I'm going to start off with our axion coronal T2H sequences, certainly going to look at all the organs, but we'll be focused on the bile ducts. You can already see here that the bile duct is visible and whatever it's visible, most likely it's dilated because normal bile ducts are very, very tough to see on these T2H sequences because they're so small. Scroll a little bit lower and you can definitely see that the biantropatic bile ducts are dilated. You can see here that there's almost a trifrification variation as a side where both the anterior, posterior and left seem to be coming to a specific spot. But again, we don't need to worry too much about that. This patient is not somebody being considered for liver resection. The common hepatic duct is dilated as well and you can see the cystic duct coming and joining it over here. And you can go all the way down and the common bile duct is dilated, but over time goes sort of slowly tapers until it gets to the ampule or right at the duodenum. When we look at sort of the biliary tree, we notice that there's no apparent ideology for these findings. There's no fill-in defects inside of it to suggest colidoglythiasis. I'm not seeing layering sludge inside of it. There is biliriductal dilatation if the ideologies is uncertain. Let's look at it on the coronal images, see if that helps us at all. Again, we can see biliriductal dilatation. The right hepatic ducts and some of the left hepatic ducts are dilated. The extrapatic biliridtree is dilated and you can see it coming all the way down and right into the ampule with no apparent ideology that we can figure out. We also did a 3D MRCP sequence over here. It shows the findings very beautifully. However, as we go all the way down, the extrapatic biliridtree no apparent ideology identified. And we have a whole bunch of post-contrast sequences as well in this instance and really no ideology identified for the ductal dilatation in this patient. One of the things when you dig deeper into the history of this patient is you realize that the patient has infected with HIV and in fact has AIDS. And so one of the things to consider in patients with that is this entity, who have biliriductal dilatation and this history, is this entity of AIDS cholangiopathy. And what this is is inflammation of the bile ducts related to AIDS related opportunistic infections thought to be potentially cryptosporidium or cytomegalovirus. And as a result of that inflammation, you can get biliridtree strictures and potentially papillaries stenosis. So right where the bile ducts enter the ampule right at that location at the major papilla, you can get some papillaries stenosis. And if that occurs, the bile ducts upstream from it, all this stuff can dilate. Now there's a variety of imaging patterns that have been described with AIDS cholangiopathy. Certainly papillaries stenosis is one of them, which is something that this patient may have had and can account for some of the imaging findings we see. But you can also get areas of intrapathic biliriductal stricturing and dilatation. And in fact, it can have appearance that is very similar to primary sclerosis and cholangitis, a case that we've already covered in this master course. And so I think in this instance, if you see that sort of pattern, it's very important to dig in deep for the clinical history. If the patient who has low CD4 counts and you have sort of a primary sclerosis and cholangitis picture, consider that in fact the imaging appearance is not due to a sclerosis and cholangitis, but rather AIDS cholangiopathy. Be that as it may in this instance, these dilated ducts don't have the appearance of primary sclerosis and cholangitis. They're dilated all the way to the ampula and given the history in this patient, likely there's some element of papillary stenosis resulting in this ductal dilatation.