Abstract
Extrahepatic obstruction of the portal vein (EHPVO) with resulting portal hypertension may cause extensive collateral venous circulation at the porta hepatis. Portal hypertensive biliopathy (PHB) refers to abnormalities of the biliary tract in patients due to these portoportal collaterals. 1,2 These collateral veins are related to 2 preformed venous systems near the extrahepatic bile ducts: the paracholedochal (PACD) veins of Petren, and the epicholedochal (ECD) venous plexus of Saint. The PACD venous plexus of Petren runs parallel to the CBD, and the ECD plexus of Saint veins form a reticular mesh on the surface of the CBD. 3,4 The PACD collaterals, if dilated, may cause extrinsic compression and protrusion into the thin and pliable CBD, and the ECD collaterals, if dilated, may make the normallysmoothintraluminalsurfaceoftheCBDirregular. 5,6 Detection of these dilated venous collateral vessels is important for making the diagnosis of PHB. Detection of large PACD and ECD collaterals has been done by color Doppler US (CDUS). 7 Smaller collaterals are identified by EUS, color Doppler EUS (CD-EUS), and intraductal EUS. 8-10 On magnetic resonance imaging, PACD collaterals and ECD collaterals are identified separately. 11,12
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