Common Bile Duct Wall Thickening Due to Intramural Varices Diagnosed by Colour Doppler Ultrasound

Zusammenfassung

Fälle von Gallengangswandverdickung, verursacht durch variköse Erweiterung der intramuralen Venen infolge einer Pfortaderthrombose, sind selten. Sie stellen ein differenzialdiagnostisches Problem dar, da sie morphologisch ein Cholangio-Karzinom vortäuschen können. In der Fachliteratur wurden bisher lediglich einzelne Fälle von farbdoppler-sonographischen Beschreibungen von Gallengangsvarizen veröffentlicht. Im Folgenden berichten wir über einen Patienten mit einer Wandverdickung der extrahepatischen Gallenwege bei kavernöser Transformation bei Pfortaderthrombose und einem Verschlussikterus. Mit Farbdoppler-Sonographie konnte der Kollateralkreislauf in der verdickten Gallengangswand nachgewiesen werden. Ein Verschlussikterus bei Gallengangsvarizen ist eine Rarität. Der Verschlussikterus im vorgestellten Falle war schließlich auf eine Neoplasie im Pankreaskopf zurückzuführen.

Abstract

Cases of common bile duct (CBD) wall thickening due to varicose dilation of intramural veins consequential to portal vein thrombosis (PVT) are rare and present a considerable differential diagnostic problem, as they can mimic cholangiocarcinoma. In such cases, colour Doppler ultrasound (CD US) is a very valuable diagnostic method. There are only a few reports in literature on CD US findings of collateral circulation in a thickened CBD wall following PVT. A patient with obstructive jaundice, a tumour of the pancreatic head, CBD wall thickening, and pre-existing PVT is presented. CD US demonstrated collateral circulation of the thrombosed portal vein in the thickened wall of the common bile duct, thus ruling out a mass in the CBD. Obstructive jaundice seldom occurs with choledocal varices. In this patient, the bile duct obstruction was due to the carcinoma of the pancreatic head.

Key words

Jaundice, obstructive - common bile duct neoplasms - ultrasonography - Doppler, colour

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