Question

A 35-year-old male presents with recurrent episodes of abdominal pain, jaundice, and fatigue and underwent MRCP. What will be the most likely diagnosis?

• A. Primary biliary cirrhosis
• B. Caroli's disease
• C. Primary sclerosing cholangitis
• D. Oriental cholangitis

Hint:

Beaded ducts with multifocal strictures in a young man, think of the biliary disease tied to IBD.

Answer 1

The Correct Option is C

Step 1: Read the MRCP. It shows multifocal short strictures of the bile ducts alternating with normal or mildly dilated segments, giving an irregular, 'beaded' appearance of both the intrahepatic and extrahepatic biliary tree.
Step 2: Match it to the clinic. A young man with recurrent abdominal pain, jaundice, and fatigue, plus beaded strictures, is the classic picture of primary sclerosing cholangitis (PSC), which is also strongly linked to inflammatory bowel disease.
Step 3: Confirm. The diagnosis of PSC rests mainly on cholangiography (MRCP or ERCP) showing the irregular, narrowed, beaded ducts.
Why the others are wrong: Primary biliary cirrhosis (cholangitis) is a small-duct disease of middle-aged women with AMA positivity and no large-duct beading. Caroli's disease shows saccular cystic dilatation of intrahepatic ducts (central dot sign). Oriental (recurrent pyogenic) cholangitis shows ducts packed with pigment stones.
Ref: Bailey and Love, Short Practice of Surgery, 27th edition, Page 1167.