1. INTRAMURAL CBD COLLATERALS –
MIMICKER OF CHOLANGITIS/
CHOLANGIOCARCINOMA
DR. RUSHABH SHAHDR. RUSHABH SHAH,,
CONSULTANT RADIOLOGISTS,CONSULTANT RADIOLOGISTS,
INFOCUS DIAGNOSTICS, AHMEDABAD, GUJARAT.INFOCUS DIAGNOSTICS, AHMEDABAD, GUJARAT.

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

4. SPLENOMEGALY
PARTIAL PV
THROMBOSIS
MULTIPLE PORTOSYSTEMIC
COLLATERALS

5. 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

6. 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.

7. 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.