I think that final psc diagnosis is made by mrcp or ersp. Typical findings are the bead appearance of ducts SWITCHING stenosis dilatation .It would help me a lot if you write your own findings as reported by the radiologist. They mention the strictures or those meant when there are dilatationw My magnetic states only diffuse mild dilatations I try to have diagnosis my alone. A repeat mrcp in two weeks
thanks Dennis. My best wishes for you
This is what mine read in March 2015:
Findings: Again noted is mild intrahepatic biliary ductal dilatation
with mild focal narrowing of the confluence of the intrahepatic ducts
and common hepatic duct which is not significantly changed. Also again
noted is enhancement around the confluence of ducts, again noted are
porta hepatis, peripancreatic, and retrocaval lymph nodes. These have
all slightly increased in size, and the porta hepatis node on image 34
of series 14 enhances. This node has increased in size from 7 mm to 9
mm since the prior exam. The peripancreatic lymph node best seen on
image 25 of series 15 has increased in size from 18 mm x 16 mm 18 mm x
17 mm. The retrocaval lymph node has increased in size from 7 mm to 9
mm. In addition, there is now a small peripheral arterially enhancing
linear lesion on image 54 of series 14 in segment 6 that does not
demonstrate washout, a nonspecific finding, possibly a perfusion
abnormality. Also noted is a vague area of peripheral enhancement
surrounding an area of low signal intensity measuring 18 mm in diameter
in segment 7 on image 30 of series 14 which is not seen on T1 or
T2-weighted imaging. Its appearance is nonspecific but bears attention
on followup imaging. Again noted is splenomegaly, measuring 13.8 cm in
length.
The pancreas, kidneys, and adrenal glands are normal in appearance.
There is no ascites. There is no significant retroperitoneal
lymphadenopathy.
Conclusion: Findings are again compatible with primary sclerosing
cholangitis with a stricture at the confluence of the intrahepatic and
common hepatic ducts with enhancement of the confluence of ducts. The
enhancement could be separated due to the patient's underlying
cholangitis, but malignancy cannot be excluded. Of concern is
enlargement of 3 lymph nodes in the vicinity of the bile ducts since
the prior exam, also raising suspicion of developing malignancy.
Therefore, suggest consideration of ERCP and possible SpyGlass
evaluation and biopsy of the biliary hilum.
thank you very much jeffdc for the reply. Ι note a very detailed description of your findings.I see that the narrowing is noted. My daughters reference is very brief and notes only difuse mild dilatations which two hepatologists do not see and left lobe increase in size. in a week will make a repeat mrcp and tomorrow blood tests (alp ...). I spend very difficult times. I dread the moment i hear the diagnosis. I am in this situation about a year.
when you do the suggested examinations? How you feel? I wish and hope the best news for you.
forgive me for the bad use of my English
Vango,
I am supposed to have imaging once a year. I suppose this is subject to change.
One thing about this disease for both patient, family/caregivers-it tests your patience and sense of humor.
I get several twinges of discomfort a week in my right and left upper quadrants, barely hitting the pain scale, but I know it's there. I usually get tired in the late afternoons and sometimes sleep for an hour when I get home from work. All things considered, life is good. I have come up with the theory that any day outside of a hospital is a $&#$^ good day.
No sweat on the English-it's better than my Greek!
How is your daughter doing?
Jeff
vango said:
thank you very much jeffdc for the reply. Ι note a very detailed description of your findings.I see that the narrowing is noted. My daughters reference is very brief and notes only difuse mild dilatations which two hepatologists do not see and left lobe increase in size. in a week will make a repeat mrcp and tomorrow blood tests (alp ...). I spend very difficult times. I dread the moment i hear the diagnosis. I am in this situation about a year.
when you do the suggested examinations? How you feel? I wish and hope the best news for you.
forgive me for the bad use of my English
have you someone new on your case of malignancy? do you check igg4 for pancreas pseudotumor which causes swelling of the lymph nodes? igg4 cholagitis and pancretitis responses to corticosteroides.I am looking for alternative and promising diagnoses. how varied the Alp from the beginning of your diagnosis? My daughter is very well. No symptoms at all from her liver and terminal ileitis.she is very optimistic about her health she believes she has nothing, and that her mother has gone mad due to internet searching.
Vango,
My ALP is high, currently close to 200. It hit over 400 during a cholangitis attack, but I am not sure about going back to 2013 when I was diagnosed.
My CA 19 is excellent. I have seen on some report that the igg4 level was good. No malignancy was found, but I have blood work every three months, and imaging once a year, so we'll can be aware of any changes. There have been several reports that my pancreas is fine. But I do have my doubts as I occasionally get some twinges on the upper left side.
That your daughter has no symptoms is wonderful, but that someone deny for a long time the fact that they have it while they have no symptoms. But then, is it better to have no symptoms? No clear answer in every case.
Moms know best, don't they?
hi JeffDC.we have good news. Τhe alp is 100 ( normal upper limit 104). What's your normal upper limit?
Once the doctors tell you that your pancreas is well so it will be. in Greece say a wise proverb. "Whoever burned to the milk and yogurt blows". the same applies to you and me, I guess.
The normal range here is 34-104. Glad the alp is in that range.
Never heard that wise proverb.
Jeff
vango said:
hi JeffDC.we have good news. Τhe alp is 100 ( normal upper limit 104). What's your normal upper limit?
Once the doctors tell you that your pancreas is well so it will be. in Greece say a wise proverb. "Whoever burned to the milk and yogurt blows". the same applies to you and me, I guess.