Presentation
The patient has a known case of idiopathic portal hypertension and underwent a transjugular intrahepatic portosystemic shunt (TIPS) procedure.
Patient Data
Contracted gallbladder with wall thickening and multiple mural serpentine blood vessels representing gallbladder varices. Multiple paraumbilical, splenic, and perigastric collaterals. Massive splenomegaly.
Multiple collaterals in the porta hepatis, suggesting cavernous malformation.
Case Discussion
Presence of abnormal collateral vessels is one of the most sensitive and specific signs for the diagnosis of portal hypertension. Gallbladder varices, in particular, represent a form of portosystemic shunt that develops in patients with portal hypertension as collaterals.
Ultrasound is the most sensitive imaging technique for diagnosis. Greyscale ultrasound usually reveals a thickened gallbladder wall, with numerous serpentine, cystic structures lying in the wall and the pericholecystic bed. Color Doppler images show venous flow in these structures, with low-velocity continuous wave, confirming the presence of varices.
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