IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Minimal change primary sclerosing cholangitis

Case contributed by Jan Frank Gerstenmaier

Presentation

P-ANCA positive and abnormal LFTs.

Patient Data

Age: 50 years
Gender: Female

CT intravenous cholangiogram

ct

Excellent quality study. The entire biliary tree as well as the gallbladder are opacified. There are no filling defects within the gallbladder or biliary tree that would indicate calculus. The common bile duct measures 8 mm in diameter and tapers smoothly towards the ampulla. There is a jet of contrast observed from the polar across the duodenum, and further contrast is present in the proximal jejunum.

The intrahepatic bile ducts are abnormal with mild peripheral duct dilatation in multiple segments, beading, and a rippled appearance, particularly of the segment 2 duct. No dominant stricture is identified.

Several radiodense objects within the stomach and duodenum are shown keeping with ingested pills. Approximately 15 are counted.

Conclusion:

Negative for choledocholithiasis. The appearances of the intrahepatic ducts are very suggestive of minimal change primary sclerosing cholangitis-type abnormality. Considerations include recurrent infection, PSC and IgG4-RSD (especially considering unexplained history of pancreatitis).

Case Discussion

No diagnosis in this patient as yet, although imaging appearances are indicative of minimal change primary sclerosing cholangitis.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.