Skip to main content

Lymphadenopathy in sclerosing cholangitis: Pitfall in the diagnosis of malignant biliary obstruction

Gastrointestinal Radiology volume 17, pages 157–160 (1992)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Teefey SA, Baron RL, Rohrman CA, Shuman WP, Freeny PC. Sclerosing cholangitis: CT findings.Radiology 1988;169:635–639

    PubMed  Google Scholar 

  2. 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

    PubMed  Google Scholar 

  3. 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

    PubMed  Google Scholar 

  4. Reiman TH, Balfe DM, Weyman PJ. Suprapancreatic biliary obstruction: CT evaluation.Radiology 1987;163:49–56

    PubMed  Google Scholar 

  5. Warren KW, Athanassiades S, Monge JI. Primary sclerosing cholangitis: a study of forty-two cases.Am J Surg 1966;111:23–38

    PubMed  Google Scholar 

  6. Longmire WP. When is cholangitis sclerosing?Am J Surg 1978;135:312–320

    PubMed  Google Scholar 

  7. Engels JR, Balfe DM, Lee JKT. Biliary carcinoma: CT evaluation of extrahepatic spread.Radiology 1989;172:35–40

    PubMed  Google Scholar 

  8. Balfe DM, Mauro MA, Koehler RE et al. Gastrohepatic ligament: normal and pathologic CT anatomy.Radiology 1984;150:485–490

    PubMed  Google Scholar 

  9. Zirinsky K, Auh YH, Rubenstein WA, Kneeland JBK, Whalen JP, Kazam E. The portacaval space: CT with MR correlation.Radiology 1985;156:453–460

    PubMed  Google Scholar 

  10. Zeman RK, Schiebler M, Clark LR et al. The clinical and imaging spectrum of pancreaticoduodenal lymph node enlargement.AJR 1985;144:1223–1227

    PubMed  Google Scholar 

  11. Rahn NH, Koehler RE, Weyman PJ, Truss CD, Sagel SS, Stanely RJ. CT appearance of sclerosing cholangitis.AJR 1983;141:549–552

    PubMed  Google Scholar 

  12. Ament AE, Haaga JR, Wiedenmann SD, Barkmeier JD, Morrison SC. Primary sclerosing cholangitis: CT findings.J Comput Assist Tomogr 1983;7:795–800

    PubMed  Google Scholar 

  13. Thompson HH, Pitt HA, Lewin KJ, Longmire WP. Sclerosing cholangitis and histiocytosis X.Gut 1984;25:526–530

    PubMed  Google Scholar 

  14. Jafri SZH, Bree RL, Agha FP, Schwab RE. Inflammatory pseudotumor from sclerosing cholangitis.J Comput Assist Tomogr 1983;7:902–904

    PubMed  Google Scholar 

  15. 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

    PubMed  Google Scholar 

  16. 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

    PubMed  Google Scholar 

  17. Thompson HH, Pitt HA, Tompkins RK, Longmire WP. Primary sclerosing cholangitis: a heterogenous disease.Ann Surg 1982;196:127–136

    PubMed  Google Scholar 

  18. Bass NM, Chapman RW, O'Rielly A, Sherlock S. Sclerosing cholangitis associated with angioimmunoblastic lymphadenopathy.Gastroenterology 1983;85:420–424

    Google Scholar 

  19. Dolmatch BL, Laing FC, Federle MP, Jeffrey RB, Cello J. AIDS-related cholangitis: radiographic findings in nine patients.Radiology 1987;163:313–316

    PubMed  Google Scholar 

  20. 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

    PubMed  Google Scholar 

  21. Matieu D, Ladeb MF, Guigui B, Rousseau M, Vasile N. Periportal tuberculous adenitis: CT features.Radiology 1986;161:713–715

    PubMed  Google Scholar 

  22. Whelton MJ. Sclerosing cholangitis.Clin Gastroenterol 1973;2:163–173

    PubMed  Google Scholar 

Download references

Author information

Affiliations

  1. Departments of Radiology and Gastroenterology, New England Medical Center, Boston, Massachusetts, USA

    Eric Outwater M.D., Marshall M. Kaplan & Mark S. Bankoff

Authors
  1. Eric Outwater M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marshall M. Kaplan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark S. Bankoff
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints 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

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01888535

Key words

  • Sclerosing cholangitis, lymphadenopathy
  • Computed tomography