INTRAMURAL CBD COLLATERALS – MIMICKER OF CHOLANGITIS/ CHOLANGIOCARCINOMA

DR. RUSHABH SHAHDR. RUSHABH SHAH, ,

CONSULTANT RADIOLOGISTS,CONSULTANT RADIOLOGISTS,

INFOCUS DIAGNOSTICS, AHMEDABAD, GUJARAT. INFOCUS DIAGNOSTICS, AHMEDABAD, GUJARAT.

Enhancing thickening of suprapancreatic CBD with mild narrowing, no obstructive biliopathy

SPLENOMEGALY

PARTIAL PV THROMBOSIS

MULTIPLE PORTOSYSTEMIC COLLATERALS

DIAGNOSIS:•Partial portal venous thrombosis,•Multiple porto-systemic collaterals•Splenomegaly

•No active arterial enhancement of CBD wall thickening•Gradual venous phase filling•Confirmation of intramural collaterals on doppler

PORTAL VENOUS THROMBOSIS WITH INTRAMURAL COLLATERALS OF CBD

DISCUSSION:•Middle aged woman presented with heaviness in abdomen & pain, no previous medical or surgical history

•On Imaging: Changes of portal hypertension and CBD wall thickening, ? cholangitis ? cholangiocarcinoma

•Portal vein thrombosis leads to portal hypertension with development of cavernous transformation (CTPV) and porto-portal collaterals at the hepatic hilum. These collaterals may involve the paracholecystic, para-epicholedochal, and pancreaticoduodenal veins and bypass the obstructed portal vein segment. Portal biliopathy may develop.

•Very rarely there is cavernous transformation of veins within the wall of CBD as in our case.