Primary sclerosing cholangitis
This patient with known Crohn disease presented with abnormal liver enzymes.
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There is atrophy of the right lobe of the liver. The intrahepatic biliary tree demonstrates multifocal stricturing and beading. There is a short stricture just central to the confluence with a short segment of mild duct dilatation at 7mm with a normal calibre CBD distally at 4mm. The pancreatic duct is normal. Appearances are in keeping with early PSC.
The association between primary sclerosing cholangitis and inflammatory bowel disease is strong (in 70% of cases), as in this patient. Caudate hypertrophy is often seen in advanced disease (not present here). The most feared complication is cholangiocarcinoma which develops in up to 15% of patients.,