portal biliopathy
Portal biliopathy or portal ductopathy refers to biliary obstruction that is associated with cavernous transformation of the portal vein due to portal vein thrombosis .
Clinical presentation
Portal biliopathy may present as jaundice, cholangitis due to bile duct obstruction, or rarely as hemobilia.
Pathology
When portal vein thrombosis occurs multiple venous collaterals develop to bypass the obstruction resulting in portal cavernoma and peribiliary collateral vessels. The peribiliary collateral vessels cause extrinsic compression of the intrahepatic and extrahepatic bile ducts .
There are also underlying inflammatory and ischemic changes resulting in peribiliary fibrosis, which can also result or be amplified by repeated episodes of cholangitis, a condition to which portal biliopathy predisposes .
Classification
Portal biliopathy may be classified as :
- varicoid: obstruction by large collaterals
- fibrotic: from intramural (epicholedochal) collaterals seen as thickened and densely enhancing bile ducts
- mixed
Radiographic features
MRI
MRCP features of portal biliopathy in order of frequency are as follows:
- biliary stenosis
- wavy appearance of the bile ducts
- angulation of the CBD
- upstream dilatation of the bile ducts
Differential diagnosis
Possible differential considerations include:
Siehe auch:
- kavernöse Transformation Pfortader
- Pfortaderthrombose
- Pancreas anulare
- portale Hypertension
- Choledocholithiasis
- Gallenwegsstent
- cholangiozelluläres Karzinom
- sclerosing cholangitis
- Perkutane transhepatische Drainage (PTBD)
- Karzinom Gallenblasenhals
- Cholezystolithiasis
- choledochal varices
und weiter:
Assoziationen und Differentialdiagnosen zu Gallenwegsobstruktion:
