Gallbladder Varices: An Unusual Manifestation of Portal Hypertension

Abstract

Purpose: A 67-year-old woman with a history of hepatitis C treated 5 years ago with sustained virologic response presented with 4 weeks of right upper quadrant abdominal pain. She also reported increasing abdominal distention and an unintentional 15-pound weight loss over the past 2 months. On physical examination, the patient was jaundiced and tender to palpation in the right upper quadrant. No fluid wave was elicited. Laboratory data revealed abnormal liver tests in a cholestatic pattern including an elevated total bilirubin (11.4 mg/dL; reference range 0.2-1.1) and alkaline phosphatase (474 U/L, reference range 31-103). Abdominal ultrasound was significant for a heterogeneous appearing liver with nodularity suggestive of cirrhosis, portal vein thrombosis with occlusion of the portal vein, and intrahepatic duct dilation. Incidentally, the gallbladder was noted to be surrounded by a thickened, tortuous wall of low echogenicity. Doppler imaging detected blood flow within the gallbladder wall consistent with varices (Figure A). A computed tomography scan of the abdomen was notable for 2 enhancing masses in the liver, 4.3 cm and 2.2 cm in diameter, with associated intrahepatic biliary dilatation and the previously identified portal vein thrombosis. Again, the gallbladder varices were visualized (Figure B).Figure: A. Top - Abdominal ultrasound of the gallbladder revealed a thickened, tortuous wall around it. Bottom - Color Doppler demonstrated blood flow within the thickened gallbladder wall consistent with varices.Figure: [736] B. Computed tomography of the abdomen displayed thickened gallbladder wall (white arrows) consistent with varices.