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After portal vein occlusion, portal to portal collaterals (hepatopetal) develop from preexisting periportal vessels or recanalization of the thrombosed portal vein, undergo compensatory enlargement, bypass the obstructed extrahepatic occlusion and reconstitute the intrahepatic portal branches. Angiographically, collateral veins are seen as multiple tortous winding veins in the porta hepatis and are described as a cavemous transformation of the portal vein. When the common bile duct or gall bladder is compressed by collateral veins, a cholangiogram demonstrates multiple smooth intramural defects and jaundice can develop due to the partial obstruction of the bile duct. Demonstration of the cavernous transformation of the portal vein can be done by ultrasonography, abdominal computed tomography and nuclear magnetic resonance, but Doppler ultrasonography and direct or indirect portography are needed to evaluate its hemodynamic change. We present a 35-year-old female patient complaining repeated jaundice, in whom common bile duct and gall bladder varices accompanied by cavernous transformation of the portal vein and intrahepatic stones were diagnosed by ultrasonography, abdominal computed tomography, ERCP, and Doppler ultrasonograpy and confirmed by surgery. ERCP demonstrated the irregular contour of the common bile duct and gall bladder due to multiple smooth intramural defects. Doppler utrasongraphy revealed the unique flow signal of portal vasculature from the tortous vessls in the porta hepatis and from the vascular structures on the wall of the gall bladder.
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