Cholangiopathy in extrahepatic portal venous obstruction - Radiological appearances

Purpose: To evaluate cholangiographic abnormalities resulting from extrahep atic portal venous obstruction (EHPVO) by sonography and endoscopic retrogr ade cholangiopancreaticography (ERCP). Material and Methods: Forty-three patients with an established diagnosis of EHPVO were subjected to duplex Doppler sonography and ERCP. Of these, 8 pa tients had obstructive jaundice. Results: Dilated common bile duct with pericholedochal varices showing a co ntinuous type of dow pattern was seen in 5 EHPVO patients with obstructive jaundice. ERCP revealed cholangiographic abnormalities in 40 patients (93%) . Extrahepatic bile ducts were involved in 100% of cases compared to intrah epatic bile ducts (57%). Abnormalities noted were contour irregularity with indentations, displacement and angulation, strictures and filling defects in the extrahepatic ductal system. Intrahepatic bile ducts showed dilatatio n with areas of narrowing and filling defects. Conclusion: Cholangiographic abnormalities are very common in patients with EHPVO, even without clinical manifestations of biliary disease. Extrahepat ic bile ducts are far more often involved compared to intrahepatic bile duc ts. Extrinsic compression with contour irregularity is the most common chol angiographic finding. Sonographic findings are not diagnostic. Dilated comm on bile duct with pericholedochal varices was seen in only 5 patients.