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• W2914443577 abstract "Portal Cavernoma Colangiopathy (PCC) is characterized by biliary tract abnormalities due to extrahepatic portal vein obstruction (EHPVO). EHPVO can also cause pre-hepatic portal hypertension. Portal cavernoma refers to the expanded network of collateral vessels, sometimes mimicking a neoplasm. We report a 65-year-old man with past medical history of portal hypertension, who was admitted due to jaundice and abdominal distension. Laboratory tests were impressive for alkaline phosphatase 674 U/L, total bilirubin 6.8 mg/dL and transaminases 60 U/L. Computed tomography (CT) of the abdomen and pelvis revealed biliary ductal dilatation and a hepatic lesion suggestive of hemangioma. Magnetic resonance cholangiopancreatography (MRCP) revealed intra and extra hepatic biliary dilatation, and an irregular narrowing of the common bile duct (CBD) at the level of the porta hepatis surrounded by an ill-defined soft tissue lesion. To better asses the stricture at the CBD and unclear mass at porta hepatis, endoscopic ultrasonography (EUS) was performed. A hypoechoic mass was seen at the pancreatic head region with associated distal CBD obstruction and extensive collateral circulation. Given biliary dilation seen on CT and EUS with CBD stricture, endoscopic retrograde cholangio-pancreatography (ERCP) was performed and demonstrated a localized biliary stricture with malignant appearance. Sphincterotomy was performed and a metal stent was placed into the CBD. Fine needle aspiration from the EUS and brush cytology from ERCP were negative for malignancy. A repeat EUS showed stable vascular lesion in the peripancreatic area. A liver biopsy showed mild nodular regenerative hyperplasia (NRH) with minimal fibrosis. These cholangiographic findings were determined to be due to chronic PVT with cavernous transformation. Our paper illustrates a patient with non-cirrhotic portal hypertension associated with PVT and cavernous transformation, known as PCC. The hypoechoic mass at the peripancreatic region and biliary stricture were radiologic features of PCC. Symptomatic patients with PCC are at high-risk for sustained biliary obstruction complications, including secondary biliary cirrhosis. An association between PCC and NRH has not been previously described and likely contributed to the portal hypertension in this case. One must be aware of PCC as an important differential diagnosis with malignancy and a cause of pre-cirrhotic portal hypertension.Figure" @default.
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• W2914443577 date "2017-10-01" @default.
• W2914443577 modified "2023-09-25" @default.
• W2914443577 title "Portal Cavernoma Mimicking Pancreatic Malignancy" @default.
• W2914443577 doi "https://doi.org/10.14309/00000434-201710001-01276" @default.
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