Primary sclerosing cholangitis

  • 70% patients have history of inflammatory bowel disease – ulcerative colitis
  • Multiple segments of stricture involving intra- and/or extra-hepatic ducts
  • Bile duct wall thickening at sites of structuring 
  • Small diverticula-like outpouchings
  • Cholangiocarcinoma in 10% cases
  • Cholangiography: multifocal strictures, areas of distension, pruning of ducts, areas of ductal isolation
  • CT-IVC and MRCP: thickened biliary epithelium shows post contrast enhancement. 
  • Areas of atrophy and hypertrophy within liver
  • Bile duct stones (10% cases)
  • Cholangiocarcinoma: progressive duct dilatation proximal to stricture or if nodule is identified 
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Khoshpouri, Pegah, et al. “Imaging features of primary sclerosing cholangitis: from diagnosis to liver transplant follow-up.” Radiographics 39.7 (2019): 1938-1964.

Vitellas, Kenneth M., et al. “Radiologic manifestations of sclerosing cholangitis with emphasis on MR cholangiopancreatography.” Radiographics 20.4 (2000): 959-975.