Which cholangiographic feature is characteristic of primary sclerosing cholangitis?

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Multiple Choice

Which cholangiographic feature is characteristic of primary sclerosing cholangitis?

On cholangiography, primary sclerosing cholangitis classically shows a beaded appearance from multiple short, irregular strictures alternating with dilated segments in the bile ducts. This pattern reflects chronic inflammation with periductal fibrosis that often involves both intrahepatic and extrahepatic ducts. The beading of both duct systems is the hallmark feature you’re looking for. If ducts appear smooth and uninterrupted, that argues against PSC. Beading of the hepatic veins points to Budd-Chiari syndrome, not PSC. Dilation limited to the extrahepatic duct without intrahepatic involvement is not typical for PSC and suggests other causes of obstruction.

On cholangiography, primary sclerosing cholangitis classically shows a beaded appearance from multiple short, irregular strictures alternating with dilated segments in the bile ducts. This pattern reflects chronic inflammation with periductal fibrosis that often involves both intrahepatic and extrahepatic ducts. The beading of both duct systems is the hallmark feature you’re looking for. If ducts appear smooth and uninterrupted, that argues against PSC. Beading of the hepatic veins points to Budd-Chiari syndrome, not PSC. Dilation limited to the extrahepatic duct without intrahepatic involvement is not typical for PSC and suggests other causes of obstruction.

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