Int J Colorectal Dis (2004) 19:586–594 DOI 10.1007/s00384-004-0598-0 ORIGINAL ARTICLE Tim O. Hirche Jan Russler Barbara Braden Gudrun Schuessler Stefan Zeuzem Till Wehrmann Hans Seifert Christoph F. Dietrich Sonographic detection of perihepatic lymphadenopathy is an indicator for primary sclerosing cholangitis in patients with inflammatory bowel disease Accepted: 17 February 2004 Published online: 15 April 2004  Springer-Verlag 2004 T. O. Hirche · J. Russler · B. Braden · S. Zeuzem · T. Wehrmann Medizinische Klinik II, Klinikum der J. W. Goethe-Universität, Frankfurt am Main, Germany G. Schuessler · C. F. Dietrich ( ) ) Innere Medizin II, Caritas Krankenhaus, Uhlandstrasse 7, 97980 Bad Mergentheim, Germany e-mail: christoph.dietrich@ckbm.de Tel.: +49-7931-582201 Fax: +49-7931-582290 H. Seifert Gastroenterologie und Diabetologie, Städtische Kliniken, Dr.-Eden-Strasse 10, 26133 Oldenburg, Germany Abstract Aim: Primary sclerosing cholangitis (PSC) is a frequent com- plication in patients with inflamma- tory bowel disease (IBD). While hy- perplasia of the perihepatic lymph nodes has been described in patients with PSC, its prevalence and cause in IBD patients remains obscure. In the present study we address the ques- tion of whether ultrasound (US) ex- amination is useful to detect perihe- patic lymphadenopathy and improve the diagnostic accuracy for PSC in patients with underlying IBD. Methods: A total of 310 consecutive IBD patients were prospectively evaluated by US for enlarged peri- hepatic lymph nodes, as well as se- rologic testing for cholestasis-indi- cating enzymes. In patients with positive test results, viral or autoim- mune liver disorders were excluded by serum testing. Next, the presence of PSC was confirmed/excluded by endoscopic retrograde cholangiogra- phy (ERC). Results: Perihepatic lymphadenopathy was detected by US in 27 of 310 (9%) patients. In 9 (33%) of those, serologic testing identified an underlying autoimmune or viral hepatitis. In the remaining 18 patients, ERC confirmed PSC in 17 (94%) and excluded it in 1. Elevated cholestasis parameters were found in 43 of 310 (14%) patients and 5 (12%) of those were diagnosed with auto- immune or viral hepatitis. In the re- maining 38 patients, ERC confirmed PSC in 15 (39%) and excluded it in 23 (61%). Therefore, when autoim- mune or viral hepatitis was excluded, enlarged lymph nodes in US pre- dicted PSC more accurately than conventional serum parameters alone (PPV 94 and 39%, respec- tively [ P<0.001]), and the sensitiv- ity ratio increased by a factor of 1.13 in favor of the US examination. Conclusion: In patients with IBD, detection of enlarged perihepatic lymph nodes is a highly predictive indicator for the presence of PSC. Alternative causes of perihepatic lymphadenopathy have to be exclud- ed. Keywords Ultrasound · Inflammatory bowel disease · Primary sclerosing cholangitis · lymphadenopathy Introduction Crohn’s disease and ulcerative colitis, collectively known as inflammatory bowel disease (IBD), are chronic, spon- taneously relapsing enteropathies of unknown etiology. IBD produces a wide range of gastrointestinal and ex- traintestinal symptoms with considerable morbidity and impact on the patient’s quality of life [1]. Several hepa- tobiliary abnormalities in association with IBD have been described, such as primary sclerosing cholangitis (PSC), cirrhosis and cholangiocarcinoma [2]. PSC, characterized by fibrosing strictures of the intra- and extrahepatic bile ducts and progressive liver failure, is the most common form of chronic inflammatory liver disease in IBD pa-