Hepatobiliary Iminodiacetic Acid Scanning Detects High-Grade Biliary Obstruction Secondary to IgG4-Related Sclerosing Cholangitis.

In this report, we present a case of high-grade biliary obstruction discovered on hepatobiliary scintigraphy secondary to IgG4-related sclerosing cholangitis with concomitant autoimmune pancreatitis, a recently described entity that is gaining recognition in the radiology literature. To our knowledge, the scintigraphic findings have yet to be described in the literature. We present the hepatobiliary scintigraphic findings and their correlation to findings on endoscopic retrograde cholangiopancreatography, CT, and MR cholangiopancreatography, with posttreatment follow-up imaging. IgG4-related sclerosing cholangitis is a rare yet important diagnostic consideration when high-grade obstruction is seen on hepatobiliary iminodiacetic acid scanning. We discuss the differential diagnosis of high-grade biliary obstruction seen on hepatobiliary iminodiacetic acid scanning.