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Contribution of color Doppler sonography to the characterization of an unusual thickening of the common bile duct.

A 36-year-old man living in Algeria developed abdominal pain, asthenia, jaundice, and vomiting. He had no medical or surgical history. Laboratory tests revealed anemia, leukopenia, cytolysis, cholestasis and hyperbilirubinemia. Gastroscopy showed esophageal varices and duodenal cap ulcerations suggestive of portal hypertension. Abdominal sonography displayed a thickening of the common bile duct, splenomegaly and absence of gallbladder stones. Two months later, the patient was admitted in our institution for progressive asthenia. A contrast enhanced CT scan was performed, showing a tubular soft-tissue enhancing mass extending from the porta hepatitis to the head of the pancreas within the hepato-duodenal ligament. Intra and extrahepatic bile ducts were not dilated. The main portal vein and the intrahepatic branches of the portal vein appeared normal on axial CT scans. An additional ultrasound was performed, showing a non-dilated common bile duct (arrow Fig. A) with a marked thickening of the common bile duct wall and small serpiginous vessels within the thickening either in power Doppler as in color Doppler (arrowheads Figs. B and C). Additionally, a short and thigh narrowing of the main portal vein proximally to the portal division was disclosed, and secondarily confirmed on the multiplanar reformations of the contrast enhanced CT scan. A medullary biopsy was performed in the context of bicytopenia and splenomegaly and showed myelofibrosis.