title: Imaging and clinical characteristics of focal atrophy of segments 2 and 3 in primary sclerosing cholangitis.
abstract: OBJECTIVE
  Focal atrophy in primary sclerosing cholangitis (PSC) is usually thought to result from severe biliary stricture and focal biliary cirrhosis. Atrophy of the left lateral segments (segments 2 and 3) are striking when observed grossly. This type of atrophy may be subtle on cross-sectional imaging and by endoscopic retrograde cholangiopancreatography (ERCP) because of the peripheral location and compensatory hypertrophy of other parts of the liver. We examined 44 consecutive PSC patients to determine the incidence and clinical characteristics of this abnormality, and to correlate imaging studies with the gross appearance.
  
  
  METHODS
  We reviewed all cases of PSC encountered over a 3 year period ascertained from the liver disease registry. Magnetic resonance imaging or CT images were re-examined for evidence of segment 2 and 3 atrophy.
  
  
  RESULTS
  Four of 44 patients had focal segment 2 and 3 atrophy. These four had been confirmed laparoscopically or by inspection of the liver explant. The remaining segments of the liver were relatively spared of injury in two of the patients, and three of the four patients had preserved synthetic function without evidence of portal hypertension. While the abnormality is clearly visible on cross-sectional imaging, its peripheral location caused it to be an unobtrusive. Likewise, ERCP did not clearly reveal the abnormality on initial inspection.
  
  
  CONCLUSIONS
  We conclude that focal atrophy of segments 2 and 3 is a sometimes early and subtle finding in PSC that may be overlooked in cross-sectional imaging or ERCP unless specifically sought.
authors.affiliation: The University of Virginia, Department of Internal Medicine, Charlottesville, United States of America. shc5c@virginia.edu
authors.forename: S H
authors.initials: SH
authors.lastname: Caldwell
authors.forename: E E
authors.initials: EE
authors.lastname: Hespenheide
authors.forename: D
authors.initials: D
authors.lastname: Harris
authors.forename: E E
authors.initials: EE
authors.lastname: de Lange
mesh_terms: D000328:Adult; D000368:Aged; D001284:Atrophy / Q000000981:diagnostic imaging / Q000209:etiology; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging / Q000473:pathology*; D001660:Biliary Tract Diseases / Q000150:complications*; D015209:Cholangitis, Sclerosing / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed