History of acute cholecystitis secondary to biliary stricture status post biliary stent placement. History of pancreatitis. ABDOMEN:LIVER, BILIARY TRACT: There is moderate intrahepatic biliary ductal dilatation to the level of the common hepatic duct, increased from the prior especially in the right hepatic lobe. The visualized common hepatic duct demonstrates diffuse circumferential wall thickening and a focal region of enhancement and thickening centrally (series 1203, image 428). The common bile duct stent is noted resulting in surrounding susceptibility artifact.Contracted gallbladder with percutaneous cholecystostomy tube.Small cyst near the right hepatic dome. No suspicious focal lesion. Transient hepatic intensity difference noted in the posterior segment of the right hepatic lobe. The vessels are patent.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic pancreas. There is mild prominence of the main pancreatic duct at the level of the pancreatic body with an abrupt transition point without a focal lesion, suspicious for a stricture although an underlying neoplasm cannot be excluded (series 801/57).ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Several round regions of decreased T2 weighted signal intensity in the kidneys bilaterally with decreased enhancement and associated striated nephrograms, similar to prior CT. No hydroureteronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild basilar atelectasis.
Long segment peripherally thickened enhancing stricture of the proximal common hepatic duct with increasing upstream biliary ductal dilatation. Given the history of negative EUS/ERCP bile duct brushings (as cholangiocarcinoma/malignancy can appear similarly) and constellation of findings in the kidneys and pancreas auto-immune sclerosing cholangiopathy should be considered.Prominence of the main pancreatic duct with abrupt transition at the pancreatic body without a focal lesion, suspicious for a stricture (similar etiology as above) although underlying neoplasm cannot be excluded.The renal findings described could also be a manifestation of IgG4 related autoimmune disease.