Pathogenesis of Portal Cavernoma Cholangiopathy: Is it Compression by Collaterals or Ischemic Injury to Bile Ducts During Portal Vein Thrombosis?

Portal cavernoma is the cavernous transformation of the portal vein. It is the consequence of chronic portal vein thrombosis and occurs when collateral branches develop to bypass the portal occlusion. The clinical presentation includes hematemesis due to variceal bleeding, ascites or anemia, and splenomegaly. Herein we present images of a 37-year-old male patient received in our department for abdominal ultrasound, following 2 episodes of hematemesis. This case illustrates the ultrasound aspect of a voluminous portal cavernoma with portal hypertension signs.

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Mass-Like Extreme Wall Thickening of the Entire Common Bile Duct in a Case of Portal Cavernoma Cholangiopathy

Journal of Gastrointestinal and Abdominal Radiology ◽

10.1055/s-0041-1735216 ◽

2021 ◽

Author(s):

Veeraraghavan Gunasekaran ◽

Supraja Laguduva Mohan ◽

Sunitha Vellathussery Chakkalakkoombil ◽

Kuppusamy Senthamizhselvan

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Wall Thickening ◽

Imaging Features ◽

Biliary Pain ◽

Immunoglobulin G4 ◽

Vein Thrombosis ◽

Portal Cavernoma

AbstractPortal cavernoma cholangiopathy (PCC) refers to the cholangiographic abnormalities that occur in patients with portal cavernoma. These abnormalities may be either due to chronic portal vein thrombosis or extrahepatic portal vein occlusion. These abnormalities occur due to enlargement of the bridging tortuous paracholedochal, epicholedochal, and cholecystic veins exerting pressure on the bile ducts. Ischemic changes can also occur in the bile duct due to portal vein thrombosis, which affects the microvascular circulation or associated hepatic artery thrombosis. These may be either reversible with shunt procedures such as transjugular intrahepatic portosystemic shunt (TIPS) or irreversible in the advanced stage, leading to recurrent episodes of biliary pain, cholangitis, and cholestasis. Occasionally it may present as mass-like diffuse common bile duct (CBD) wall thickening, which may be confused with mimickers like primary CBD lymphoma, immunoglobulin G4-related sclerosing cholangitis, and even cholangiocarcinoma on imaging. Thus, we need to be aware of the mass-forming PCC imaging findings to avoid unnecessary invasive procedures like biopsy or surgical intervention. Here, we present a case of PCC, which presented as mass-like diffuse CBD wall thickening with patent lumen on ultrasound that led to further workup with contrast-enhanced computed tomography and magnetic resonance imaging. The wall thickening showed persistent delayed enhancement, no significant diffusion restriction, and there was also associated superior mesenteric vein thrombosis with multiple mesenteric collaterals. A positron emission tomography-CT scan also ruled out malignant disease as there was no uptake. Finally, a diagnosis of mass-forming PCC was made by combining imaging features and excluding other causes.

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Portal Vein Thrombosis Mimicking Tumour and Causing Obstructive Jaundice

Acta Radiologica ◽

10.1177/02841851960373p253 ◽

1996 ◽

Vol 37 (3P2) ◽

pp. 685-687 ◽

Cited By ~ 3

Author(s):

R. Nyman ◽

H. Al-Suhaibani ◽

I. Kagevi

Keyword(s):

Obstructive Jaundice ◽

Portal Vein ◽

Female Patient ◽

Portal Vein Thrombosis ◽

Bile Ducts ◽

Endoscopic Retrograde Cholangiography ◽

Endoscopic Retrograde ◽

Vein Thrombosis ◽

Intrahepatic Bile Ducts ◽

Extrahepatic Bile Ducts

The case of a 28-year-old female patient with portal vein thrombosis mimicking tumour and causing obstructive jaundice is presented. The cavernous-transformed enlarged portal vein, explaining the mass-like lesion in the hepatic hilum on ultrasonography, compressed the extrahepatic bile ducts and caused obstructive jaundice. Endoscopic retrograde cholangiography demonstrated multiple nodular extrinsic indentations of the extrahepatic bile ducts with moderately dilated intrahepatic bile ducts.

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