title: Two cases of immunoglobulin G4-related sclerosing cholangitis in which transabdominal ultrasonography was useful in diagnosis and follow-up observation.
abstract: Immunoglobulin G4-related disease (IgG4-RD) represents a group of disorders that share features of inflammation, plasma cell infiltrates, and fibrosis. Sclerosing cholangitis is a disorder involving inflammation, scarring, and destruction of the bile ducts. IgG4-related sclerosing cholangitis (IgG4-SC) has been proposed as a bile duct lesion associated with IgG4-RD. This disease entity can be distinguished from other types of sclerosing cholangitis and classified into four types based upon the region of strictures revealed by cholangiography. Here, we present two cases in which the finding of bile duct wall thickening visualized with transabdominal ultrasonography was useful in the diagnosis of patients with IgG4-SC. At present, transabdominal ultrasonography is not included in the diagnostic algorithm for IgG4-SC. We are certain that detailed observation of the bile duct wall with transabdominal ultrasonography can make a significant contribution to the diagnosis of IgG4-SC. Furthermore, we propose that transabdominal ultrasonography may be useful in following clinical improvement in cases where a steroid trial is the best option for treatment. Both cases emphasize the practicality of transabdominal ultrasonography in the diagnosis and follow-up observation of IgG4-SC.
authors.affiliation: Department of Gastroenterology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
authors.forename: Ikuhiro
authors.initials: I
authors.lastname: Kobori
authors.affiliation: Department of Gastroenterology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
authors.forename: Toshikuni
authors.initials: T
authors.lastname: Suda
authors.affiliation: Department of Gastroenterology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nakamoto
authors.affiliation: Department of Gastroenterology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Saito
authors.affiliation: Department of Gastroenterology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Okawa
authors.affiliation: Department of Gastroenterology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
authors.forename: Rion
authors.initials: R
authors.lastname: Sudo
authors.affiliation: Department of Gastroenterology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Gyotoku
authors.affiliation: Department of Gastroenterology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan.
authors.forename: Yasumi
authors.initials: Y
authors.lastname: Katayama
authors.affiliation: Department of Gastroenterology, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama, 343-8555, Japan. mstamano@dokkyomed.ac.jp.
authors.forename: Masaya
authors.initials: M
authors.lastname: Tamano
mesh_terms: D000368:Aged; D001652:Bile Ducts / Q000000981:diagnostic imaging*; D015209:Cholangitis, Sclerosing / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000276:immunology* / Q000473:pathology; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*
chemical_list: D007074:Immunoglobulin G
keywords: IgG4; IgG4-related disease; IgG4-related sclerosing cholangitis; Immunoglobulin; Sclerosing cholangitis; Transabdominal ultrasonography