Primary sclerosing cholangitis

Case contributed by Dr Ali Abougazia

Presentation

Recurrent abdominal pain and jaundice.

Patient Data

Age: 50 years
Gender: Male

Dilated CBD with beaded appearance of the intra-hepatic biliary radicles with irregular dilatations and strictures as well as numerous variable sized intra-ductal calculi (hepatolisthiasis) being of high T1GRE and low T2 GRE signals.

Complementary CT and ultrasonographic examination showed these calculi to be heavily calcified.

CT Abdomen

CT

Dilated CBD and intra-hepatic biliary radicles with calcified hepatolisthiasis.

Liver ultrasound

Ultrasound

Intra-ductal calculi (hepatolisthiasis) with posterior acoustic shadowing.

Dilated CBD.

Case Discussion

The described picture is that of primary sclerosing cholangitis.

The main differential diagnosis in this case is oriental cholangiohepatitis. However, the patient is not asian and there is no history of parasitic infestation, thus the diagnosis of oriental cholangiohepatitis is unlikely.

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