Rare localization of a portal cavernoma in the wall of the common bile duct

Novellas, S.; Chevallier, P.; Peroux, J.-L.; Bruneton, J.

doi:10.1016/s0899-7071(04)00002-6

Cited by 10 publications

(8 citation statements)

References 8 publications

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“…Our experience also shows that cavernomatosis of the main biliary tract is not a rare and unusual condition as suggested by the available literature, but is probably a more frequent condition often confused with other causes of parietal thickening of the biliary tree and gallbladder. 6,7,25 The thickness of the MBD wall found was always between 5 mm and 9 mm. These values confirm the work of Denys et al 7 in which the three patients showed wall thickening between 5 mm and 6 mm.…”

Section: Discussionmentioning

confidence: 88%

“…Thus, this diagnosis is fundamental for an appropriate therapeutic treatment, which is reserved exclusively for symptomatic cases 8,9 and is important to avoid the onset of potentially life-threatening complications, such as massive bleeding, during the execution of some procedures such as ECRP and choledocholithotomy. 6,10 Previous studies have shown the wall of the biliary tract affected by cavernomatosis have a thickness ranging from 5 to 6 mm. 7 Portal and biliary cavernomatosis is caused by portal hypertension, seen in 40% of cases with extrahepatic obstruction of the portal vein (EHOPV).…”

Section: Introductionmentioning

confidence: 99%

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

Girolamo

Galassi

Merola

et al. 2020

Journal of Gastrointestinal and Abdominal Radiology

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Objective Myelofibrosis is a rare chronic myelolymphoproliferative disease and is associated with increased risk of venous thromboembolism. The objective of this study is to retrospectively evaluate patients with primary myelofibrosis who underwent abdominal US, MDCT and MRI, in order to identify the development of portal thrombosis and its correlation with portal-biliary cavernoma. Methods We evaluated 125 patients with initial diagnosis of primary myelofibrosis and nonspecific abdominal pain who had undergone US with color Doppler. In 13 patients (8 men, 5 females; age: 45–85), US detected portal thrombosis with associated portal-biliary cavernoma. All patients subsequently underwent contrast-enhanced MDCT and MRI and 4 patients MR-cholangiography. The correlation between primary myelofibrosis and portal thrombosis and cavernoma respectively was calculated using χ2 test. Results About 10% of patients with primary myelofibrosis preliminary evaluated with US had partial (8 pts) or complete (5 pts) portal thrombosis associated with portal-biliary cavernoma with a χ2 = 0. In all patients, US detected a concentric thickening of main bile duct (MBD) wall (mean value: 7 mm); color Doppler always showed dilated venous vessels within the thickened wall of the biliary tract. Contrast-enhanced CT and MRI confirmed thickening of MBD walls with their progressive enhancement and allowed better assessment of the extent of the portal system thrombosis. MR-cholangiography showed a thin appearance of the MBD lumen with evidence of ab extrinsic compression. Conclusions The evidence of portal thrombosis and portal-biliary cavernoma in 10% of the patients with primary myelofibrosis indicates a close correlation between the two diseases. In the detection of portal thrombosis and portal-biliary cavernoma, US with color Doppler is the most reliable and economical diagnostic technique while contrast-enhanced MDCT and MRI allow better assessment of the extent of the portal vein thrombosis and of the complications of myelofibrosis.

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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

Girolamo

Galassi

Merola

et al. 2020

Journal of Gastrointestinal and Abdominal Radiology

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“…23,24 There are rare case reports of portal biliopathy characterized localization of the portal cavernoma in the wall of the bile duct causing thickening of the walls of the bile duct along with dilatation of the intrahepatic biliary ducts with no evidence of extrinsic compression by collaterals on magnetic resonance (MR) imaging. 25 The evidence in favor of compression by dilated venous collaterals comes in the form of: a) Imaging evidence of collaterals impinging on bile duct lumen.…”

Section: Reversible Component Of Portal Cavernoma Cholangiopathymentioning

confidence: 99%

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

Puri

2014

Journal of Clinical and Experimental Hepatology

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The pathogenesis of portal cavernoma cholangiopathy (PCC) is important as it can impact the choice of treatment modalities. PCC consists of a reversible component, which resolves by decompression of collaterals as well as a fixed component, which persists despite the decompression of collaterals. The reversible component is due to compression by large collaterals located adjacent to the bile duct as well as possibly intracholedochal varices. The fixed component is likely to be due to ischemia at the time of portal vein thrombosis, local ischemia by compression as well as encasement by a solid tumor-like cavernoma comprising of fibrous hilar mass containing multiple tiny collateral veins rather than markedly enlarged portal collaterals. Although cholangiographic abnormalities in portal hypertension are common, the prevalence of symptomatic PCC is low. This is likely to be related to the cause of portal hypertension, the duration of portal hypertension and possibly the pattern of occlusion of the splenoportal axis. There may possibly be higher prevalence of symptomatic PCC in extension of the thrombosis to the splenomesentric veins.

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“…Varices in the CBD wall were called CBD wall varices (probably related to intramural ECD collaterals) and varices outside the CBD wall were called PCD collaterals (probably related to PCD venous plexus). 6,7 However if the CBD wall is taken as a landmark for differentiation of varices in a manner analogous to the gut wall, varices can be classified in relation to three layers of CBD wall, namely fibro muscular layer, subepithelial layer and epithelium lining the CBD lumen.…”

Section: Classifying Collateralsmentioning

confidence: 99%

“…[4][5][6] The paracholedochal venous plexus of Petren probably represents obliterated right umbilical vein and apparently has an embryological origin independent of the portal vein and is related to the accessory portal venous system. 7 Normally, venous drainage of CBD is bidirectional. The paracholedochal plexus comprises of two veins, the 3 o'clock and 9 o'clock marginal veins, that run parallel to the CBD in the hepatoduodenal ligament, but not in contact with the CBD wall (Figure 1), and are interconnected with multiple large transverse channels.…”

mentioning

confidence: 99%

Portal Cavernoma Cholangiopathy: An Endoscopic Ultrasound Based Imaging Approach

Sharma

Rameshbabu²

2014

Journal of Clinical and Experimental Hepatology

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In patients with portal cavernoma cholangiopathy (PCC), appearance and location of collateral channels depends on extent and location of occlusive thrombus in the porto-mesenteric venous system. If the porto-mesenteric venous system is occluded near the formation of portal vein, blood tends to flow through collateral channels that form varices in and around the common bile duct. Though endoscopic ultrasound (EUS) is considered the investigative modality of choice for evaluating common bile duct obstruction, its role in evaluating collateral pathways in and around the common bile duct is poorly defined. This article reviews the anatomy, genesis and appearance of these collateral pathways in PCC. EUS identifies different layers of the common bile duct (CBD) wall and, in PCC, where varices are in close contact with or part of these different layers, can establish the relationship between them. Thus, EUS appears to be the investigation of choice for tracing the origin and course of collaterals in PCC. Careful study of varices in the common bile duct wall prior to ERCP for bile duct stones or biliary strictures may help to plan the procedure and to manage anticipated complications such as hemobilia. ( J CLIN EXP HEPATOL 2014;4:S53-S61) B oth porto-systemic and porto-portal collaterals can develop in response to chronic occlusion of the portal venous system. The location and extent of occlusive thrombus in the porto-mesenteric venous system determine the type of collaterals that eventually develop and the direction of collateral flow.

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Rare localization of a portal cavernoma in the wall of the common bile duct

Cited by 10 publications

References 8 publications

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

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

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

Portal Cavernoma Cholangiopathy: An Endoscopic Ultrasound Based Imaging Approach

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