Collateral biliary circulation in portal hypertension syndrome

OBJECTIVE: to describe collateral circulation in the gallbladder wall in re lation with portal hypertension syndrome, and to determine whether this syn drome is frequently associated portal vein thrombosis. METHODS:images were retrospectively reviewed for 9 patients with previously diagnosed portal hypertension syndrome, in whom ultrasound results suggest ed the presence of varices of the cystic vein. RESULTS: four patients showed signs suggesting portal win thrombosis. The g allbladder wall showed diffuse hypoechoic thickening in all patients, 7 of whom had intramural dilation of tubular, tortuous appearance. Ultrasound fi ndings, however, were not very specific, and differential diagnosis with a large number of other entities is required to rule out other possible cause s of focal and diffuse thickening of the gallbladder wall. The use of Doppl er sonographic techniques made it possible to determine the cause of the va rices, and to confirm suspicions of portal thrombosis. This method was foun d to be just as sensitive as ultra-sound imaging, and much more specific. A ngiograms obtained in 3 patients for different reasons confirmed the ultras onographic findings in all cases. CONCLUSIONS this study confirms the association between thromboses and vari ces, and analyzes the physiopathological hypotheses invoked to explain this association. We emphasize the need for correct diagnosis, given the freque ncy of surgical iatrogenic bleeding or misdiagnosis resulting from confusio n with other possible causes of gallbladder wall thickening. Doppler ultras ound is considered the ideal diagnostic method as it is harmless, sensitive and specific.