Patient from Southeast Asia with recurrent attacks of RUQ pain, jaundice and itching for 8 years
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- Marked irregular dilatation of the intra-hepatic biliary radicles, more appreciated centrally in the right lobe, with abrupt transitions into non-dilated ducts suggesting stricture formation, and showing multiple intra-ductal calculi of low T2 & high T1 signals, suggestive of pigment stones.
- The CBD also shows irregular dilatation with several calculi in its lumen.
- Bilobed GB devoid of masses/calculi.
- Bulky pancreatic head surrounding the 2nd part of duodenum (annular pancreas).
- Enlarged liver with diffuse fat infiltration.
The overall findings of intra & extrahepatic biliary radicle dilatation and strictures, with intra-ductal calculi, in absence of GB calculi, is highly suggestive of recurrent pyogenic cholangiohepatitis (oriental cholangiohepatitis), particularly for a patient from Southeast Asia. A definitive diagnosis would require ERCP (which wasn’t done in this case as the patient didn't attend again following this study and to the best of our knowledge, wasn't done prior to this attendance).
The differential diagnosis includes strictures following previous cholangitis/pancreatitis (especially in the presence of annular pancreas), primary sclerosing cholangitis & cholangiocarcinoma.