An unusual presentation of primary sclerosing cholangitis

Figure 1 CT scan illustrating saccular dilations (arrows) of right and left hepatic ducts.

Figure 2 MRCP demonstrating saccular dilation (arrows) of the right and left hepatic ducts.

Figure 3 ERCP. A: Initial cholangiogram showing dilated extrahepatic ducts consistent with diagnosis of type IV choledochal cysts (arrowhead), and 7 cm common duct stricture (arrow); B: Final balloon occlusion cholangiogram performed one year after stenting showing resolution of the common duct stricture and cystic biliary dilation. The intrahepatic ducts are diffusely irregular.

Figure 4 Liver biopsy. A: Pretreatment Trichome stain showed cirrhosis; B: Trichrome stain one year later following biliary stenting showed marked improvement in degree of fibrosis.