Primary sclerosing cholangitis: sonographic findings

BACKGROUND: To determine the value of sonography of the upper abdomen in primary sclerosing cholangitis (PSC). METHODS: In a prospective study of 23 patients with PSC we performed upper abdominal sonography. Sonographic findings of the bile ducts were correlated with endoscopic retrograde cholangiographic (ERC) findings. Signs of advanced disease and complications were also sought. RESULTS: The major limitation of ultrasound was its inability to exclude intrahepatic duct disease. In six patients with multiple strictures and pruning but without dilatations on ERC, sonography showed no intrahepatic duct abnormalities. Extrapheptic duct disease was adequately demonstrated on ultrasound. Mural thickening of the common bile duct (CBD), the hallmark of PSC in the appropriate clinical setting, was demonstrated in 17 of 18 cases with a stenosis on ERC. Ultrasound confirmed advanced disease manifested by signs of portal hypertension in seven patients. Marked nonsegmental intrahepatic duct dilation and the presence of a mass lesion occurred in two of three cases in which complicating cholangiocarcinoma was found. CONCLUSION: Despite its inability to exclude intrahepatic duct disease, sonography is useful in diagnosing and following PSC