26 years, Male, Reason: H/o PSC, elevated alk phos, eval for disease progression History: see above. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Peripheral regions arterial enhancement which do not persist on subsequent phases likely represent transient hepatic intensity differences. No suspicious hepatic lesions are evident.The common bile duct is dilated to 1 cm, proximal to an approximately 2 cm segment of narrowing and irregularity of the distal common bile duct, new from the prior exam. There are multiple regions of narrowing and dilatation involving the intrahepatic bile ducts giving a beaded appearance, increased from the prior exam. The right common bile duct is particularly narrowed at its confluence.SPLEEN: Multiple splenic cysts are overall similar in appearance to the prior exam. A large T2 hyperintense complex cystic lesion in the anterior spleen with multiple enhancing septations and progressive centripetal enhancement is unchanged in size measuring 3.5 x 2.8 cm (501/34), previously 3.4 x 2.8 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild diffusion restriction, thickening and minimal enhancement within the relatively ahaustral colon and terminal ileum.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.
1.Multiple foci of intrahepatic and extrahepatic stricturing, increased from the prior exam, suggestive of primary sclerosing cholangitis.2.Diffusion restriction, enhancement and ahaustral colon is suggestive of inflammatory bowel disease with terminal ileitis.3.Multiple splenic cysts, including a larger nonspecific enhancing complex cystic lesion, are stable.