Primary sclerosing cholangitis

Case contributed by Dr Abdallah Khateeb

Presentation

Long-standing history of abdominal pain and diarrhea. Recently developed obstructive jaundice and weight loss.

Patient Data

Age: 35 years old
Gender: Female

Liver protocol CT scan

Modality: CT
Modality: MRI

Case Discussion

There is intra- and extra-hepatic biliary tracts dilatation, with multiple intraluminal tumefactive sludge material of different size and density, which showed no enhancement on dynamic imaging (judged by HU, not only visually), some of these are calcified (hepatolithiasis), being hyperdense on CT. A diverticulum-like outpouching arising from the left main intrahepatic duct is also seen, better seen on MRI. The gallbladder is enlarged containing few small dependent gallstones.

On the CT PV images, the colon up to the level of cecum, is of edematous slightly hyperenhancing mucosa, with numerous abnormal mesenteric lymph nodes and fat stranding. Further workup confirmed inflammatory bowel disease.

Diverticulum-like outpouchings of the bile ducts are considered pathognomonic for primary sclerosing cholangitis. The association of PSC with inflammatory bowel disease is classical.

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Case Information

rID: 44733
Case created: 3rd May 2016
Last edited: 8th May 2016
Inclusion in quiz mode: Included

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