Abstract
We retrospectively reviewed abdominal computed tomographic (CT) studies from 20 patients with sclerosing cholangitis and found evidence of abdominal lymphadenopathy in 13 patients. Enlargement occurred primarily in areas draining the liver, such as the gastrohepatic ligament or celiac axis (N=8), the porta hepatis (N=7), and the pancreaticoduodenal region (N=2). One patient had reactive adenopathy and retroperitoneal fibrosis. The presence of benign reactive lymphadenopathy in at least one intraabdominal location was confirmed by pathological examination of excised lymph nodes in seven patients. Malignancy was excluded by surgical exploration or clinical follow-up.
We conclude that enlarged lymph nodes are a common finding by CT in patients with sclerosing cholangitis. Enlarged reactive lymph nodes in this condition should not be mistaken for evidence of periportal metastasis or cholangiocarcinoma.
Similar content being viewed by others
References
Teefey SA, Baron RL, Rohrman CA, Shuman WP, Freeny PC. Sclerosing cholangitis: CT findings.Radiology 1988;169:635–639
Nesbit GM, Johnson CD, James EM, MacCarty RL, Nagorney DM, Bender CE. Cholangiocarcinoma: diagnosis and evaluation of resectability by CT and sonography as procedures complementary to cholangiography.AJR 1988;151:933–938
MacCarty RL, LaRussao NF, May GR, Bender CE, Wiesner RH, King JE, Coffey RJ. Cholangiocarcinoma complicating primary sclerosing cholangitis: cholangiographic appearances.Radiology 1985;156:43–46
Reiman TH, Balfe DM, Weyman PJ. Suprapancreatic biliary obstruction: CT evaluation.Radiology 1987;163:49–56
Warren KW, Athanassiades S, Monge JI. Primary sclerosing cholangitis: a study of forty-two cases.Am J Surg 1966;111:23–38
Longmire WP. When is cholangitis sclerosing?Am J Surg 1978;135:312–320
Engels JR, Balfe DM, Lee JKT. Biliary carcinoma: CT evaluation of extrahepatic spread.Radiology 1989;172:35–40
Balfe DM, Mauro MA, Koehler RE et al. Gastrohepatic ligament: normal and pathologic CT anatomy.Radiology 1984;150:485–490
Zirinsky K, Auh YH, Rubenstein WA, Kneeland JBK, Whalen JP, Kazam E. The portacaval space: CT with MR correlation.Radiology 1985;156:453–460
Zeman RK, Schiebler M, Clark LR et al. The clinical and imaging spectrum of pancreaticoduodenal lymph node enlargement.AJR 1985;144:1223–1227
Rahn NH, Koehler RE, Weyman PJ, Truss CD, Sagel SS, Stanely RJ. CT appearance of sclerosing cholangitis.AJR 1983;141:549–552
Ament AE, Haaga JR, Wiedenmann SD, Barkmeier JD, Morrison SC. Primary sclerosing cholangitis: CT findings.J Comput Assist Tomogr 1983;7:795–800
Thompson HH, Pitt HA, Lewin KJ, Longmire WP. Sclerosing cholangitis and histiocytosis X.Gut 1984;25:526–530
Jafri SZH, Bree RL, Agha FP, Schwab RE. Inflammatory pseudotumor from sclerosing cholangitis.J Comput Assist Tomogr 1983;7:902–904
Bartholonew LG, Cain JC, Woolner LB, Utz DC, Ferris DO. Sclerosing cholangitis: its possible association with Riedel's struma and fibrous retroperitonitis—report of two cases.N Engl J Med 1963;269:8–12
Alberti-Flor JJ, Kalemeris G, Dunn GD, Avant GR. Primary sclerosing cholangitis associated with massive intra-abdominal lymphadenopathy.Am J Gastroenterol 1986;81:55–60
Thompson HH, Pitt HA, Tompkins RK, Longmire WP. Primary sclerosing cholangitis: a heterogenous disease.Ann Surg 1982;196:127–136
Bass NM, Chapman RW, O'Rielly A, Sherlock S. Sclerosing cholangitis associated with angioimmunoblastic lymphadenopathy.Gastroenterology 1983;85:420–424
Dolmatch BL, Laing FC, Federle MP, Jeffrey RB, Cello J. AIDS-related cholangitis: radiographic findings in nine patients.Radiology 1987;163:313–316
Clark A, Zeman RK, Choyke PL, White EM, Burrell MI, Grant EF, Jaffe MH. Pancreatic pseudotumors associated with multifocal idiopathic fibrosclerosis.Gastrointest Radiol 1988;13:30–32
Matieu D, Ladeb MF, Guigui B, Rousseau M, Vasile N. Periportal tuberculous adenitis: CT features.Radiology 1986;161:713–715
Whelton MJ. Sclerosing cholangitis.Clin Gastroenterol 1973;2:163–173
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Outwater, E., Kaplan, M.M. & Bankoff, M.S. Lymphadenopathy in sclerosing cholangitis: Pitfall in the diagnosis of malignant biliary obstruction. Gastrointest Radiol 17, 157–160 (1992). https://doi.org/10.1007/BF01888535
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01888535