Primary Sclerosing Cholangitis

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Austin J Radiol. 2016; 3(4): 1057.

Primary Sclerosing Cholangitis

Mukherjee P*, Srinivasan S and Chinchure D

Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore

*Corresponding author: Mukherjee P, Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, 768828, Singapore

Received: August 22, 2016; Accepted: October 06, 2016; Published: October 07, 2016


We present a case of a 47-year-old woman with non-specific symptoms and signs of anaemia. Her liver function tests were abnormal and Anti-Nuclear Antibodies (ANA) was significantly elevated. Magnetic Resonance Cholangio- Pancreaticography (MRCP) revealed multiple strictures of intrahepatic ducts and colonoscopy revealed mucosal inflammation and polyps. Imaging-guided liver biopsy was also performed and the findings were compatible with Primary Sclerosing Cholangitis (PSC) with ulcerative colitis. Patient was treated for anaemia and appropriate drugs were prescribed for the auto-immune condition. Prevalence of PSC is very rare in Singapore. It is characterized primarily by inflammation and fibrosis of the biliary tree. It is associated with inflammatory bowel disease and a host of other conditions, eventually leading to cirrhosis and death. Diagnosis is achieved by imaging, laboratory markers and histology. ERCP is the current gold standard investigation, although MRCP is the noninvasive investigation of choice. Early diagnosis and medical intervention slow the disease progression and decrease mortality and morbidity.

Keywords: Sclerosing cholangitis; MRCP; Inflammatory bowel disease


A 47-year-old woman presented with exhaustion and shortness of breath on exertion. She also had history of occasional giddiness. She had regular menses and no abdominal pain or malena. On general examination, pallor was present. Abdominal examination revealed mild tenderness in the right upper quadrant. There was no guarding or rigidity. Rest of the physical examination was unremarkable. She had history of stones in the gall bladder and bile duct for which she had undergone Endoscopic Retrograde Cholangio-Pancreaticography (ERCP) and removal of a calculus few years ago. She was diagnosed to have iron deficiency anaemia at that time, but she did not undergo any further evaluation. Presently, her haemoglobin was low (6.4 g/ dl) and liver function tests were abnormal (Alkaline phosphatase – 423U/L (normal range 22-104 U/L), Gamma glutaryltransferase 664U/L (normal range 7-32 U/L). Aspartate Transamine (AST) was 97 (normal range 10-30U/L)) and the albumin: globulin ratio was reversed. The bilirubin and alkaline transaminase were within normal limits. Antinuclear Antibodies (ANA) were significantly elevated measuring 210%. Other autoantibodies were negative Colonoscopy was done as a part of investigation for anaemia and features of pancolitis were observed with pseudopolyps in the descending and sigmoid colon (Figure 1). Inflammation was also noted in the terminal ileum (active colitis was proven by biopsy as well). Ultrasonography of the abdomen was unremarkable. Magnetic Resonance Cholangio- Pancreaticography (MRCP) was done in view of abnormal liver function tests (Figure 2). What is the diagnosis?

Citation: Mukherjee P, Srinivasan S and Chinchure D. Primary Sclerosing Cholangitis. Austin J Radiol. 2016; 3(4): 1057. ISSN : 2473-0637