Presentation
Long-standing history of abdominal pain and diarrhea. Recently developed obstructive jaundice and weight loss.
Patient Data
There is intra- and extra-hepatic biliary tracts dilatation, with multiple intraluminal tumefactive sludge material of different sizes and densities, 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 a few small dependent gallstones.
On the CT PV images, the colon up to the level of the cecum, is of edematous slightly hyperenhancing mucosa, with numerous abnormal mesenteric lymph nodes and fat stranding. Further workup confirmed inflammatory bowel disease.
There is intra- and extra-hepatic biliary tracts dilatation, with intraluminal tumefactive sludge material of different sizes. A diverticulum-like outpouching arising from the left main intrahepatic duct is better seen on MRI. The gallbladder is enlarged containing a few small dependent gallstones.
Case Discussion
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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