Sunday, January 15, 2012

Primary Sclerosing Cholangitis

When we see intrahepatic bile duct dilatation with strictures and only mild dilatation, the first diagnosis we think of is primary sclerosing cholangitis (PSC).
We know however that there is a long differential diagnistic list which includes:

  • Cholangiocarcinoma
  • Metastatic disease (especially breast cancer)
  • Iatrogenic bile duct strictures
  • Unusual biliary tumors (granular cell tumor)
  • Secondary sclerosing cholangitis due to:
    • Ischemia, for example post -Chemoembolisation
    • AIDS related cholangiopathy

The case on the left nicely demonstrates the bile duct strictures.
Notice that there is only mild dilatation, which is common in PSC.



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