Presentation
Recurrent abdominal pain and jaundice.
Patient Data
Dilated CBD with beaded appearance of the intra-hepatic biliary radicles with irregular dilatations and strictures as well as numerous variable sized intra-ductal calculi (hepatolisthiasis) being of high T1GRE and low T2 GRE signals.
Complementary CT and ultrasonographic examination showed these calculi to be heavily calcified.
Dilated CBD and intra-hepatic biliary radicles with calcified hepatolisthiasis.
Intra-ductal calculi (hepatolisthiasis) with posterior acoustic shadowing.
Dilated CBD.
Case Discussion
The described picture is that of primary sclerosing cholangitis.
The main differential diagnosis in this case is oriental cholangiohepatitis. However, the patient is not asian and there is no history of parasitic infestation, thus the diagnosis of oriental cholangiohepatitis is unlikely.