Primary sclerosing cholangitis

Case contributed by Dr Paul Simkin

Presentation

Ulcerative colitis on colonscopy.

Patient Data

Age: 65
Gender: Male
Modality: MRI

MRCP

Findings:

Multiplanar multisequence imaging of the pancreas and biliary tree. No prior imaging is available for comparison.

A 12 mm irregular stricture in mid common bile duct is associated with mild proximal dilation (8 mm). A 1.5 cm stricture is seen in the common hepatic duct, extending from the left and right duct confluence to the level of the cystic duct insertion.

The intra hepatic ducts have a beaded appearance, consistent with multiple regions of stricturing and dilation. Intrahepatic duct dilation is most severe in segments 2 and 3, which are atrophic, suggesting a dominant stricture. Segment 5 ducts are also more prominent that other segments, though less so than segments 2/3.

The pancreas and pancreatic duct are unremarkable. Normal appearance to the spleen, adrenals and kidneys (aside from a simple cyst on the left).

Conclusion:

Multiple intra- and extra-hepatic strictures are consistent with primary sclerosing cholangitis.

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Case Information

rID: 33367
Case created: 9th Jan 2015
Last edited: 18th Oct 2016
Inclusion in quiz mode: Included

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