-WhyisessentialtodistinguishPSCfromSSC?

-Howtomakethisdistinction?

-Isitpossible?

PrimaryandSecondarySclerosingCholangitis

APRACTICALGUIDEFORDIAGNOSTICMANAGEMENTBASEDONIMAGINGPATTERN

HannaR.F.DallaPria,MD1,LeticiaF.Bueno,MD1,LuizaSenna,MD1,PriscilaSilva,MD1,RafaelSantiago,MD1,2,

UlyssesTorres,MD,PhD3,FernandaVelloni,MD1,2,AngelaCaiado,MD3,DarioTiferes,MD,PhD3,GiuseppeDippolito,MD,PhD1,3

1-UniversidadeFederaldeS?oPaulo;2-DiagnósticosdaAméricaS.A.DASA;3-FleuryMedicinaDiagnóstica

TeachingPoints

Sclerosingcholangitis(SC)enclosesaspectrumofchronicprogressivecholestaticliverdiseasescharacterizedbyinflammation,fibrosisandstenosisofbileducts,whichareclassicallydividedintoprimarysclerosingcholangitis(PSC)andsecondarysclerosingcholangitis(SSC).

PSChasidiopathicinvolvementandanyotherpossiblesecondarycausesofcholangiopathymustbeexcluded.Drugtherapyisusedtosymptomaticreliefandtoslowdiseaseprogression,butlivertransplantationistheonlycurativetherapy.

SSCischaracterizedbyidentificationofacausalfactor.Specifictreatmentforeachcauseisfundamental,withreversionofthelesionsbeingobservedinsomecases.

PracticalGuide

?Whataretheimagingfeaturessuggestiveofsclerosingcholangitis?

?Beadappearanceofbiliarytree

?Strictures,segmentaldilatation

?Prunedtreeaspect.

Illustrativeguide:Biliatytreestenosis(yellowarrows);Gallstones(dottedwhitearrow);Dilatation(solidwhitearrow);Hepaticabcess(latestage)

IlustrativeGuide:Hepaticarterythrombosis;stenosisofthemiddlethirdof

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