Portal Biliopathy: A Review of Imaging Features of Nine Patients

Aim: To discuss the etiology, pathogenesis, diagnosis and management of PB, supported by a series of 9 cases from a personal series. Methods: Radiological images of 9 cases of PB were retrieved from different hospitals and studied and information relating to PB was obtained from various internet databases including PUB Med, Google, Google Scholar and Educus. Results: Portal biliopathy (PB) is a rare complication of extra-portal venous obstruction. 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 set the scene for formation biliary stones and cholangitis. Liver function test abnormalities are common but remain non-specific. 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. Conclusions: PB is a rare but significant complication of portal venous obstruction that has an insidious onset and may remain asymptomatic until late. PB has associated coagulopathies, and a variety of other disorders, which are discussed, illustrated and the diagnosis-elaborated. The role of MRI as a non-invasive imaging tool is emphasized.