Vascular and biliary abnormalities mimicking cholangiocarcinoma in patients with cavernous transformation of the portal vein: role of color Doppler sonography.
OBJECTIVE
The purpose of this study was to describe and evaluate the sonographic and color Doppler features of tumorlike biliary and venous changes in patients with cavernous transformation of the portal vein (CTPV).


METHODS
The sonographic studies of 24 patients with CTPV were reviewed. Sonographic evaluation of the biliary system included measurement of intrahepatic and extrahepatic biliary duct caliber changes and common bile duct (CBD) wall thickening and character. Color Doppler features of the portoportal collateral circulation at various locations (intrahepatic, periportal, gallbladder, pancreatic, and gastric regions) were carefully evaluated.


RESULTS
Biliary abnormalities were detected in 13 (54%) of 24 patients with CTPV. All 13 patients (100%) had intrahepatic biliary dilatation; 11 patients (85%) had CBD abnormalities: diffuse CBD wall thickening causing diffuse narrowing of the true lumen in 7 (54%) and CBD dilatation proximal to the focal area of narrowing due to pericholedochal compressing venous collaterals in 4 (30%). A tumorlike solid mass appeared on the gray scale images of 2 patients (8%): 1 at the porta hepatis and the other at the pancreatic head level. Color Doppler imaging evaluation showed venous-type flow, suggesting a bulk of varicosities.


CONCLUSIONS
Portoportal collaterals in patients with CTPV may alter the biliary and venous systems, causing biliary wall thickening, stenosis, intrahepatic and extrahepatic dilatation, and pseudotumors. Detailed sonographic and color Doppler imaging assessment can show and facilitate the correct diagnosis of those changes, thus avoiding the need for a more invasive modality such as endoscopic retrograde cholangiopancreatography or a more expensive investigation such as magnetic resonance cholangiopancreatography.
Kessler
Ada
A
Division of Ultrasound, Department of Radiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. kesslera@tasmc.health.gov.il
Graif
Moshe
M
Konikoff
Fred
F
Mercer
Diego
D
Oren
Ran
R
Carmiel
Michal
M
Blachar
Arye
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D001649:Bile Duct Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging; D001652:Bile Ducts / Q000000981:diagnostic imaging / Q000473:pathology*; D002648:Child; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging; D003097:Collateral Circulation; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color; D020246:Venous Thrombosis / Q000150:complications