Description

IgG4-related sclerosing cholangitis can cause a variety of patterns on cholangiography.


Analysis: cholangiography

 

Key Findings

Type

stenosis only in the distal common bile duct

1

diffuse stenosis of intra- and extrahepatic bile ducts with prestenotic dilation of intrahepatic bile ducts

2a

diffuse stenosis of intra- and extrahepatic bile ducts without prestenotic dilation of intrahepatic bile ducts

2b

stenosis in the hilar region and in distal common bile duct

3

stenosis only in the hilar region

4

 

where:

• Type 3 is combination of Types 1 and 4

 

Bile Duct Changes

Type

dilatation of the intra- and extra-hepatic bile ducts

1

narrowing of intrahepatic bile ducts; extrahepatic bile duct may be distended with stenosis of distal common bile duct

2a

narrowing of intrahepatic bile ducts with reduced bile duct branches; extrahepatic bile duct may be distended with stenosis of distal common bile duct

2b

stenosis in the hilar region and in distal common bile duct

3

stenosis only in the hilar region

4

 

Differential diagnosis:

(1) cholangiocarcinoma (Types 1, 3, and 4)

(2) pancreatic cancer (Type 1)

(3) primary sclerosing cholangitis (Type 2)


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