Female 75 years old with elevated liver enzymes s/p ERCP 7/21/16 with findings suggestive of PSC vs secondary PSC vs PBCs s/p bilateral stents in place . Now recently with worsening LFTs and leukocytosis, evaluate. ABDOMEN:LIVER, BILIARY TRACT: The wall of the common bile duct is thickened and the lumen is irregular with a stricture of the proximal common duct at the level of Klatskin's point. Filling defects within the common bile duct representing either stones or air due to recent sphincterotomy. Multiple intrahepatic biliary strictures are also noted and unchanged. There is mild thickening of the gallbladder wall however the gallbladder is contracted and not well evaluated.Subcentimeter T2 hyperintense lesions near the dome of the liver are unchanged.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is mildly irregular and dilated up to the level of the ampulla with a maximum diameter of 7 mm. Several subcentimeter side branch IPMNs in the pancreatic body are unchanged (series 3, image 15).ADRENAL GLANDS: Small left adrenal adenoma is redemonstrated.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Again seen within the infrarenal abdominal aorta is an intraluminal linear focus raising the question of focal dissection (series 11, image 28).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
Thickening, irregularity and narrowing of the common duct appears similar to the previous exam. The differential diagnosis includes PSC, autoimmune cholangitis and infectious etiologies.