The presence and significance of lymphadenopathy detected by CT in primarysclerosing cholangitis

Patients with primary sclerosing cholangitis (PSC) are at increased risk of developing cholangiocarcinoma, which adversely affects their survival, esp ecially after orthotopic liver transplantation. All CT scans of patients wi th PSC referred to the Liver Unit at the Queen Elizabeth Hospital since 199 2 were reviewed. The location of any lymph node with a short axis diameter greater than normal was documented. The incidence of lymphadenopathy and ch olangiocarcinoma was also documented. 36 scans are reviewed, including eigh t with cholangiocarcinoma as well as PSC. Abdominal lymphadenopathy was pre sent in 26 cases (66%) and 45 separate lymph node groups were involved in t hese patients. There were eight cases of cholangiocarcinoma; five were dete ctable on CT, but only four had significant lymphadenopathy. The remaining three cases of cholangiocarcinoma were not detectable on CT and only one of these had lymphadenopathy. Follow-up of the remaining patients has not dem onstrated the development of cholangiocarcinoma. Lymphadenopathy is commonl y demonstrated by CT in PSC patients, but does not imply malignancy and sho uld not exclude a patient from undergoing liver transplantation. Conversely cholangiocarcinoma may develop without significant lymphadenopathy.