A 45-year-old woman presents with recurrent episodes of right upper quadrant pain and episodic jaundice. MRCP reveals multiple stones within the intrahepatic biliary radicles of the left lobe with left hepatic atrophy. This presentation is most consistent with:

• A Primary sclerosing cholangitis
• B Klatskin tumor (hilar cholangiocarcinoma)
• C Recurrent pyogenic cholangitis (hepatolithiasis) ✓
• D Choledochal cyst type IV

Explanation

Recurrent pyogenic cholangitis (also called hepatolithiasis or Oriental cholangiohepatitis) classically presents with episodic biliary pain and jaundice due to pigment stones forming within the intrahepatic bile ducts, often with lobar atrophy from chronic biliary obstruction. Left lobe predominance is characteristic. PSC tends to cause beading of intrahepatic ducts without lobar atrophy. Klatskin tumor causes hilar obstruction with ductal dilation. Choledochal cysts are congenital dilations of the biliary tree.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.