Common Bile Duct Wall Thickening Due to Intramural Varices Diagnosed by Colour Doppler Ultrasound

Abstract

Cases of common bile duct (CBD) wall thickening due to varicose dilation of intramural veins consequential to portal vein thrombosis (PVT) are rare and present a considerable differential diagnostic problem, as they can mimic cholangiocarcinoma. In such cases, colour Doppler ultrasound (CD US) is a very valuable diagnostic method. There are only a few reports in literature on CD US findings of collateral circulation in a thickened CBD wall following PVT. A patient with obstructive jaundice, a tumour of the pancreatic head, CBD wall thickening, and pre-existing PVT is presented. CD US demonstrated collateral circulation of the thrombosed portal vein in the thickened wall of the common bile duct, thus ruling out a mass in the CBD. Obstructive jaundice seldom occurs with choledocal varices. In this patient, the bile duct obstruction was due to the carcinoma of the pancreatic head.

Correlation between Primary Myelofibrosis and the Association of Portal Thrombosis with Portal-Biliary Cavernoma: US, MDCT, and MRI Features

“…For the detection of the ectasic vessels developing from the vasa vasorum of the portal vein and biliary tract, characteristic of the cavernomatous conditions, the most accurate diagnostic technique is represented by US with color Doppler, which allows one to make a definitive diagnosis, without using more expensive techniques and contrast media. 3 CT and/or MRI must be used to evaluate the extent of portal thrombosis, to follow-up thrombolytic therapy and correctly study the manifestations and complications of the underlying disease such as spleen involvement and extramedullary hematopoiesis.…”

“…The portal cavernoma and more uncommon biliary cavernomatosis are pathologies characterized by formation of hepatopetal collateral venous circles in the context of the wall of these two anatomical structures, and in most cases, they are due to a progressive obstruction of an extensive portion of the portal vein. [1][2][3] Biliary involvement in cavernomatous transformation, also called biliary cavernomatosis or portal biliopathy, is a pathological condition which has witnessed a growing interest. The first cases were reported in 1961 by Saint 4 and in 1965 by Hunt.…”

“…For a long time, the cavernous transformation of the biliary tract has been considered a very rare and unusual condition 3,6,7 ; Novellas et al 6 accidently found this pathological entity with relative greater frequency during the execution of some diagnostic imaging techniques, more frequently in the course of endoscopic retrograde cholangiopancreatography (ERCP) and MR-cholangiography.…”

Mesenteric venous collateral vessels mimicking cystic pancreatic neoplasm

“…Isolated perigastric varices may develop in cases of splenic vein thrombosis or following spleen-preserving pancreatectomy, where splenic arteriovenous structures are ligated or resected [12]. Varices are also reported within the wall of the CBD [13,14], resulting in CBD wall thickening. There was no thickening of the CBD wall since the collateral vessels in this case were present around, rather than within, the CBD wall.…”