Radiological Findings and Diagnostic Clues of Portal Biliopathy Secondary to Extrahepatic Portal Vein Thrombosis

Introduction:Portal biliopathy (PB) refers to biliary strictures that develop as a result of chronic extrahepatic portal vein thrombosis (EHPVT), most commonly due to compression by collateral venous structures such as the epicholedochal and paracholedochal plexuses.On imaging, PB can mimic both benign and malignant biliary conditions, which may lead to diagnostic uncertainty and unnecessary invasive procedures.Accurate radiologic recognition is therefore essential for guiding clinical management.This study aims to evaluate the radiologic and biochemical features of PB and to identify imaging findings that may facilitate early and non-invasive diagnosis. Materials and Methods:This retrospective study included 15 patients clinically and radiologically diagnosed with PB secondary to chronic EHPVT between January 2018 and December 2024.Imaging was assessed by an abdominal radiologist with 5 years of experience.Biliary changes, collateral vessel distribution, and lesion characteristics were evaluated using ultrasound, Doppler ultrasound, Computed Tomography (CT), and Magnetic Resonance Imaging (MRI).Biochemical parameters and clinical records were reviewed.Results: All patients demonstrated biliary strictures due to peribiliary collateral compression.Collateral types were classified as varicoid in 8 patients (53.3%), fibrotic in 3 (20%), and mixed in 4 (26.7%).Two patients (13.3%) had MFPB with lesions that were T1-weighted hyperintense, T2-weighted hypointense, showed delayed enhancement, and no diffusion restriction.Alkaline phosphatase (ALP), and gamma-glutamyl transferase (GGT) were elevated in 80% of cases; bilirubin was elevated in 46.7%.Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 5 patients (33.3%) for symptomatic management; the remainder were treated conservatively. Conclusion:PB can be identified with characteristic radiologic findings, particularly in the absence of chronic liver disease.Awareness of paracholedochal compression and mass-forming changes in the setting of portal vein thrombosis is crucial.Accurate radiologic recognition can guide proper clinical management and help avoid unnecessary invasive procedures.