Presentation
Ulcerative colitis on colonscopy.
Patient Data
MRCP
Findings:
Multiplanar multisequence imaging of the pancreas and biliary tree. No prior imaging is available for comparison.
A 12 mm irregular stricture in the 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 intrahepatic 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 than 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).
Case Discussion
Multiple intra- and extra-hepatic strictures are consistent with primary sclerosing cholangitis.