A Review on Portal Biliopathy: Imaging Features of Nine Patients

The current chapter has been aimed to discuss the aetiology, pathogenesis, diagnosis and
management of portal biliopathy (PB), supported by a series of 9 cases from a personal series. Most
patients remain asymptomatic, but some may present with raised alkaline phosphatase level,
abdominal pain, fever, and cholangitis. It tends to be associated with gallbladder (GB) wall
abnormalities, a cavernous transformation of the portal vein and choledochal varices. Extrinsic
compression of the common bile duct, (CBD), by dilated venous collaterals together with pericholedochal
fibrosis from the inflammatory process can cause portal thrombosis, which may lead to biliary stricture and
dilatation of the proximal biliary tree. These strictures do set the scene for the
formation of biliary stones and cholangitis. Imaging features are instrumental in the diagnosis of PB.
This paper presents 9 of such cases of portal biliopathy, with discussions on their causation, the
course of the disease process and management particularly minimally invasive procedure. The role of
ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI), endoscopic
retrograde cholangiopancreatography (ERCP) and direct puncture cholangiography is discussed.
Surgical management is evaluated. An imaging atlas is provided. PB is an uncommon but significant
complication of portal venous obstruction which does have an insidious onset and may remain
asymptomatic until late. PB has been associated with coagulopathies, and a variety of other
disorders, which are discussed, illustrated and the diagnosis-elaborated. The role of MRI as a noninvasive imaging tool is emphasized.

Author (s) Details

Ali Nawaz Khan
North Manchester General Hospital, Manchester, UK.

Ken Uzoka
North Manchester General Hospital, Manchester, UK.

Sumaira Macdonald
Silk Road Medical, Inc., Sunnyvale, CA, USA.

Abeeku Afedzi Hammond
Department of Trauma and Orthopaedics, Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Bury, UK.

Anthony Kodzo-Grey Venyo
Department of Urology Delaunay, North Manchester General Hospital, Manchester, UK.

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