Presentation
Newly deranged LFTs, no obvious cause on US. Surgical team requested MRCP. Background of chronic renal impairment, longstanding lithium treatment for bipolar disorder.
Patient Data
Unremarkable appearance of the gallbladder, with 3 mm polyp but no obvious calculi.
Enlarged hepatic duct, measures up to 12 mm in diameter. The CBD is compressed and appears relatively slit-like axially. No obvious cause for this on MRCP and no ductal calculi. Conventional biliary anatomy, with normal insertion of the cystic duct. Normal imaged pancreatic duct.
Polycystic kidneys - numerous small cysts have replaced much of the renal parenchyma. Background of longstanding lithium use noted - findings are consistent with lithium nephropathy.
Otherwise unremarkable appearances of the remainder of the imaged upper abdominal organs.
Case Discussion
Lithium is recognized to cause direct damage to the renal tubules. Patients with lithium-induced renal disease will show a steady decline in renal function. The kidneys often demonstrate numerous microcysts.