Purpose: Portal biliopathy is the presence of bile duct abnormalities secondary to cavernous transformation, without other biliary tract disease or malignancy. It may be misdiagnosed as a tumor. Therefore, it is important to identify and correctly diagnose this pathology to prevent because the conglomerate of vessels may be misdiagnosed as tumor, and attempting biopsy of these structures is dangerous, with increased risk of hemorrhage also at ERCP. The purpose of this study is to evaluate whether portal biliopathy is underdiagnosed in patients with known cavernous transformation of the portal vein and whether US doppler is superior to CT or MR imaging in reaching the diagnosis.
Materials and methods: All patients diagnosed with portal vein thrombosis between 2005 and 2015 at the Tel Aviv -Sourasky Medical Center were included. The CT, US and MR imaging examinations were evaluated for the presence of cavernous transformation and portal biliopathy. The diagnosis, or absence of diagnosis, of portal biliopathy was searched for in the original radiologist’s.
Results: There were 222 patients diagnosed with portal vein thrombosis, of whom 77 had cavernous transformation. Patients with malignancy or obstructing stones (n=28) were excluded. Of the remaining 49 patients, 16 were positive for portal biliopathy on retrospective evaluation. A correct prospective diagnosis was made in only 5 of these patients (3 on US and 2 on MRI, none on CT). In the remaining 11 patients the diagnosis was misdiagnosed; not reported (n=9) or incorrectly diagnosed as tumor (n=2).
Conclusion: Portal biliopathy was found to be an underdiagnosed entity. US appears to be a more sensitive method of detection of portal biliopathy. Portal biliopathy should be suspected in patients with the combined bile duct dilatation and a known cavernous transformation of the portal vein. Referral for US may yield better accuracy at diagnosis and save the patients unwarranted biopsies.
