Sclerosing cholangitis following severe trauma: Description of a remarkable disease entity with emphasis on possible pathophysiologic mechanisms

Table 3 Diagnostic findings in posttraumatic sclerosing cholangitis during the course of the disease (ultrasound, MRT/MRCP, ERCP, and liver histology)

	Patient 1	Patient 2	Patient 3	Patient 4	Patient 5
1 - 2 mo
Ultrasound	L normal,	L normal,	L normal,	L normal,	L enlarged,
	BD normal,	BD normal,	BD normal,	BD normal,	hyperechoic,
	GB sludge	GB sludge	GB sludge	GB sludge	BD normal,
					GB contracted,
					splenomegaly
ERC	Stenoses and loss of IHBD,	-	IHBD irregular,	-	-
	CBD normal,		CBD normal,
	GB normal		GB normal
MRT/MRCP	-	-	-	L normal, BD	-
				normal, GB normal
4 - 6 mo
Ultrasound	L cirrhosis,	L inhomogeneous,	L inhomogeneous with	-	L enlarged,
			hyperechoic areas
			alongside the IHBD,		BD normal,
	BD normal,	BD normal	BD normal,		BD normal,
	GB stones		GB normal,		splenomegaly
ERC	-		IHBD: multifocal short	-	IHBD irregular,
			strictures and dilatations,		beaded
			CBD normal,		appearance,
			GB normal (Figure 2)		CBD normal,
					GB normal
Liver histology	Substantial cholestasis;	Portal tract inflammation,	Canalicular bile thrombi;	-	-
	inflammation of the portal	occasionally lymphocytes	edematously swollen
	tracts, liver lobules, and	in bile duct epithelium;	portal tracts;
	sporadically the bile ducts;	several necrotic foci with	inflammatory infiltrates,
	feathery degeneration of	foamy macrophages in	esp. around bile ducts;
	hepatocytes;	the liver acini;	occasionally feathery
	fibrosis around bile ducts;	bridging fibrosis;	degeneration of hepatocytes;
	regenerative bile duct	regenerative bile duct	minimal fibrosis
	proliferations	proliferations
12 - 24 mo
Ultrasound	L inhomogeneous cirrhosis	L enlarged, inhomogeneous,	L cirrhosis,	L cirrhosis,	-
		hyperechoic areas segment
		7/8, IHBD slightly dilated,		IHBD slightly dilated,
	BD normal,	CBD normal,	BD normal,	CBD normal,
	GB stones and sludge,	GB stones,	GB normal,	GB normal,
	splenomegaly,	splenomegaly	splenomegaly	splenomegaly
	distinct ascites
ERC	stenoses and loss of IHBD,	IHBD: loss and stenoses	-	IHBD: multifocal	-
		of right-sided bile ducts,		high-grade strictures and
		a long, stretched running		dilatations on the left side,
		left bile duct (suitable to		bile ducts on the right
		liver hypertrophy),		side not presentable,
	CBD normal,	CBD normal,		CBD normal
	GB normal	GB stones
MRT/MRCP	-	L atrophy of right liver,	L macronodular cirrhosis,	-	-
		hypertrophy of left liver;
		reduced signal intensity of
		segments 2 and 3 and
		partly 7 and 8;
		IHBD segmentally dilated,
		CBD pseudoobstruction,	CBD pseudoobstruction,
		GB stones, splenomegaly	splenomegaly
Liver histology	No cholestasis;	-	Occasionally canalicular	Substantial cholestasis (bile
	complete liver cirrhosis		cholestasis; mild	thrombi in dilated canaliculi);
			portal inflammation	occasionally lymphocytes in
			(predominantly	the epithelium of bile ducts;
			lymphocytes); some	numerous regenerative
			regenerative bile duct	bile duct proliferations in the
			proliferations; mild	periphery of portal tracts;
			fibrosis; (sampling error ?)	cirrhosis (Figure 4)

BD: bile ducts; CBD: common bile duct; GB: gallbladder; IHBD: intrahepatic bile ducts; L: liver.