First case of IgG4-related sclerosing cholangitis associated with autoimmune hemolytic anemia

Figure 1 Abdominal ultrasonograms, showing wall thickening in the region extending from the upper bile duct (A) to the intrahepatic bile duct (B).

Figure 2 Early-phase, abdominal computed tomographic scans, showing wall thickening with a contrast effect in the region from the upper biliary tract to the intrahepatic bile duct (arrows) and a strong contrast effect mainly in the hepatic parenchyma in the portal region (circle).

Figure 3 Endoscopic retrograde cholangiopancreatography images obtained before treatment. A: There were no abnormalities of the pancreatic ducts; B: Images of the right bile duct showed stricture and simple dilation after a relatively long confluent stricture (arrows), with no strictures of the lower common bile duct (circle); C, D: A band-like stricture was found in the left bile duct (circle), and a beaded appearance was seen from the upper bile duct to the left hepatic duct (arrows).

Figure 4 Endoscopic retrograde cholangiopancreatography image obtained after steroid treatment, showing that the biliary stricture situated mainly in the portal region had markedly improved.