Purpose: We undertook this study to evaluate the significance of differences in computed tomography (CT) findings between septic and non-septic acute cholangitis patients. Methods: One hundred seventy two patients were enrolled in our study. Inclusion criteria for patients were a final diagnosis of acute calculous cholangitis. Patients were divided into two groups: those who had sepsis and those that did not. The two patient groups were compared in order to investigate clinically important CT findings in acute cholangitis with and without sepsis. We also compared signs, symptoms, and laboratory findings between the groups. A p-value <0.05 was considered to be statistically significant. Results: Of the CT findings in acute cholangitis, the presence of intrahepatic duct dilatation (p<0.05), pancreatic duct dilatation (p<0.05), and pancreatitis (p<0.05) were more frequently found in the septic patient group. Septic patients showed fever (p<0.05) and chill (p<0.05) more often as presenting symptoms. Platelet count (p<0.05), segmented neutrophil portion (p<0.001), creatinine (p<0.05), and bicarbonate level (p<0.005) were significantly different in laboratory tests. Conclusion: Acute cholangitis patients with sepsis have more clinically important findings on CT, such as the presence of intrahepatic duct dilatation, pancreatic duct dilatation, and pancreatitis. Emergency physicians should focus on these findings and manage patients more urgently when these findings are present in acute cholangitis.