title: Collateral biliary circulation in portal hypertension syndrome.
abstract: OBJECTIVE
  to describe collateral circulation in the gallbladder wall in relation with portal hypertension syndrome, and to determine whether this syndrome is frequently associated portal vein thrombosis.
  
  
  METHODS
  images were retrospectively reviewed for 9 patients with previously diagnosed portal hypertension syndrome, in whom ultrasound results suggested the presence of varices of the cystic vein.
  
  
  RESULTS
  four patients showed signs suggesting portal vein thrombosis. The gallbladder wall showed diffuse hypoechoic thickening in all patients, 7 of whom had intramural dilation of tubular, tortuous appearance. Ultrasound findings, however, were not very specific, and differential diagnosis with a large number of other entities is required to rule out other possible causes of focal and diffuse thickening of the gallbladder wall. The use of Doppler sonographic techniques made it possible to determine the cause of the varices, and to confirm suspicions of portal thrombosis. This method was found to be just as sensitive as ultrasound imaging, and much more specific. Angiograms obtained in 3 patients for different reasons confirmed the ultrasonographic findings in all cases.
  
  
  CONCLUSIONS
  this study confirms the association between thromboses and varices, and analyzes the physiopathological hypotheses invoked to explain this association. We emphasize the need for correct diagnosis, given the frequency of surgical iatrogenic bleeding or misdiagnosis resulting from confusion with other possible causes of gallbladder wall thickening. Doppler ultrasound is considered the ideal diagnostic method as it is harmless, sensitive and specific.
authors.affiliation: Ciudad Universitaria "Virgen del Rocío", Sevilla, España.
authors.forename: J
authors.initials: J
authors.lastname: Morales Pérez
authors.forename: E
authors.initials: E
authors.lastname: Olloqui Martín
authors.forename: M
authors.initials: M
authors.lastname: Alcázar Iribarren
authors.forename: A
authors.initials: A
authors.lastname: Talegón Meléndez
authors.forename: J A
authors.initials: JA
authors.lastname: Nieto Parra
authors.forename: J I
authors.initials: JI
authors.lastname: Reina Sánchez De Movellán
authors.forename: A
authors.initials: A
authors.lastname: Cano Rodríguez
mesh_terms: D000293:Adolescent; D000792:Angiography; D003097:Collateral Circulation; D005260:Female; D005704:Gallbladder / Q000098:blood supply* / Q000000981:diagnostic imaging*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D012189:Retrospective Studies; D013577:Syndrome; D013927:Thrombosis; D018615:Ultrasonography, Doppler, Color; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000000981:diagnostic imaging