The presence and significance of lymphadenopathy detected by CT in primary sclerosing cholangitis.

Abstract

Patients with primary sclerosing cholangitis (PSC) are at increased risk of developing cholangiocarcinoma, which adversely affects their survival especially after orthotopic liver transplantation. All CT scans of patients with PSC referred to the Liver Unit at the Queen Elizabeth Hospital since 1992 were reviewed. The location of any lymph node with a short axis diameter greater than normal was documented. The incidence of lymphadenopathy and cholangiocarcinoma was also documented. 36 scans are reviewed, including eight with cholangiocarcinoma as well as PSC. Abdominal lymphadenopathy was present in 26 cases (66%) and 45 separate lymph node groups were involved in these patients. There were eight cases of cholangiocarcinoma; five were detectable on CT, but only four had significant lymphadenopathy. The remaining three cases of cholangiocarcinoma were not detectable on CT and only one of these had lymphadenopathy. Follow-up of the remaining patients has not demonstrated the development of cholangiocarcinoma. Lymphadenopathy is commonly demonstrated by CT in PSC patients, but does not imply malignancy and should not exclude a patient from undergoing liver transplantation. Conversely cholangiocarcinoma may develop without significant lymphadenopathy.

Expression of voltage‐gated calcium channel α2δ4 subunits in the mouse and rat retina

“…The findings on computed tomography (CT) cross‐sectional or coronal imaging of the upper abdomen are also nonspecific. CT imaging can detect thickening of the bile ducts with contrast enhancement consistent with inflammation, saccular dilatations of the intrahepatic ducts, heterogenous bile duct dilatation, document the presence of portal hypertension (i.e., varices, splenomegaly, and ascites), and identify mass lesions 18–22. It should be noted that lymphadenopathy in the abdomen is common in PSC and should not be over interpreted as metastases or a lymphoproliferative disorder 22.…”

Small Duct Sclerosing Cholangitis: A Case Report and Review of Literature

“…Serum aminotransferase levels are elevated in the majority of patients with this disease (about 2-3 times upper limits of normal), but like the alkaline phosphatase can also be in the normal range [9]. CT imaging can detect thickening of the bile ducts with contrast enhancement consistent with inflammation, saccular dilatations of the intrahepatic ducts, heterogeneous bile duct dilatation, document the presence of portal hypertensive complications (i.e., varices, splenomegaly, and ascites), and can identify mass lesions [10][11][12][13][14]. Detectable auto antibodies are found in about 97% of patients with PSC [15], these auto antibodies, however, are not routinely used for the diagnosis of PSC, as they may not be present and furthermore do not correlate with disease severity or disease prognosis [16].…”

Part 2: CT characterisation of pancreatic neoplasm: tumour mimics

“…These can become involved in multiple disease processes, including mycobacterial infections (Fig. 14) [42], gastric, biliary and hepatic malignancy [43], pancreatitis [44], lymphoma [45], sclerosing mesenteritis [46] and sclerosing cholangitis [47]. They are typically hypodense compared with pancreas in the arterial phase and often a fat plane may be demonstrated between the nodal mass and pancreas (Fig.…”