A 35 year old male presenting with recurrent episodes of abdominal pain, jaundice and fatigue underwent MRCP (shown below). What is the most likely diagnosis?
The given MRCP image which shows multiple intrahepatic and extrahepatic segments of stricturing, along with given clinical features are suggestive of Primary sclerosing cholangitis. Primary Sclerosing Cholangitis (PSC) PSC is a chronic cholestatic syndrome that is characterized by diffuse inflammation and fibrosis involving the entire biliary tree, resulting in chronic cholestasis. It leads to obliteration of both the intra- and extrahepatic biliary tree, leading to biliary cirrhosis, poal hypeension, and liver failure. Patient usually presents with fatigue , pruritis , and upper abdominal pain. Jaundice and icterus may also be present 70% cases are associated with IBD. On MRCP, it shows shows multiple intrahepatic and extrahepatic segments of stricturing , known as "Prune tree appearance". Figure1: MRCP image showing Primary Sclerosing Cholangitis Figure 2: Actual picture of tree with pruning
Primary Sclerosing Cholangitis
Primary Biliary Cirrhosis
Oriental Cholangitis
Carolis Disease
NEET Jan 2020