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Case of the Week 349




What's the most likely diagnosis?

  • 36 year-old undergoing ERCP for RUQ pain



Image from Endoscopic Retrograde Cholangio-pancreaticography
(ERCP)

  1. Pancreatic carcinoma
  2. Caroli's disease
  3. Choledocal cyst
  4. Biliary calculus
  5. Primary sclerosing cholangitis

Additional Image - Additional image from ERCP

 

Additional Image

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Image from ERCP

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Answer:

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5. Primary sclerosing cholangitis

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More (Click Discussion Tab)


Primary Sclerosing Cholangitis (PSC)

General Considerations

  • Inflammation, destruction and fibrosis of intrahepatic and extrahepatic bile ducts
  • Unknown etiology but thought to be auto-immune
  • A major cause of liver transplants in United States
  • Majority occur in association with inflammatory bowel disease (IBD)
    • Most often ulcerative colitis (UC)
      • 5% of all patients with UC have PSC
      • 75% of all patients with PSC will have UC
  • Most often between 30-60 years of age with a mean of 40
    • More common in men (70%)

    More ...


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    LearningRadiology.com
    is an award-winning educational website aimed primarily at medical students and radiology residents-in-training, containing  lectures, handouts, images, Cases of the Week, archives of cases, quizzes, flashcards of differential diagnoses and “most commons” lists, primarily in the areas of chest, GI, GU cardiac, bone and neuroradiology.