Minimal change primary sclerosing cholangitis
P-ANCA positive and abnormal LFTs.
CT intravenous cholangiogram
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Excellent quality study. The entire biliary tree as well as the gallbladder are opacified. There are no filling defects within the gallbladder or biliary tree that would indicate calculus. The common bile duct measures 8 mm in diameter and tapers smoothly towards the ampulla. There is a jet of contrast observed from the polar across the duodenum, and further contrast is present in the proximal jejunum.
The intrahepatic bile ducts are abnormal with mild peripheral duct dilatation in multiple segments, beading, and a rippled appearance, particularly of the segment 2 duct. No dominant stricture is identified.
Several radiodense objects within the stomach and duodenum are shown keeping with ingested pills. Approximately 15 are counted.
Negative for choledocholithiasis. The appearances of the intrahepatic ducts are very suggestive of minimal change PSC-type abnormality. Considerations include recurrent infection, PSC and IgG4-RSD (especially considering unexplained history of pancreatitis).
No diagnosis in this patient as yet, although imaging appearances are indicative of minimal change PSC.