Unusual mass in the hepatic portal of an 86-year-old woman

Varicose veins in the hepatoduodenal ligament and hepatic portal are normally due to cavernous transformation of the portal vein. We present an unusual case of varices of the common bile duct in an asymptomatic 86-year-old woman who was referred to our hospital for evaluation of a suspected cholangiocarcinoma. A cholangiocarcinoma could be excluded, however, and the diagnosis of intramural varicosis of the common bile duct was made with transabdominal colour Doppler sonography. Sonography showed multiple dilated vessels in the wall of the common bile duct. Most patients with choledochal varices are asymptomatic. Choledochal varices may, however, result in dilatation of the biliary system, causing raised levels of serum alkaline phosphatase and even jaundice.