Bibliographic record
Abstract
Portal cavernoma cholangiopathy (PCC) is a poorly recognized clinical entity that develops acutely and almost exclusively with extra-hepatic portal venous thrombus, if there is failure of recanalization. Majority of cases are asymptomatic with less than 25% of patients presenting with chronic cholestasis with or without biliary pain, or acute cholangitis related to biliary strictures. The grading system is based on ERCP findings, with grade I having irregularities within the biliary tree, grade II having strictures without dilation, and grade III having both strictures and dilation. Treatment modalities for mild cases include ursodeoxycholic acid and beta-blockade. Porto-systemic shunt can be considered for decompression of the portal cavernoma as long as the mesenteric and splenic veins are patent. We present a case of severe symptomatic portal cavernoma cholangiopathy. A detailed review of the case was undertaken, including history, biochemistry, and imaging studies. A subsequent literature review of the topic was conducted. A 56-year-old male, with history of remote alcoholic pancreatitis presented with new onset abdominal pain. Cholestatic liver enzyme elevation prompted imaging studies including cholangiography. On presentation, CT abdomen revealed distended gallbladder, changes consistent with chronic pancreatitis, portal vein thrombus, intra and extra-hepatic bile duct dilation. The long segment of biliary stenosis on ERCP raised suspicion for cholangiocarcinoma. Brushing was sent for cytology and was negative on two occasions. A temporary biliary stent was placed. Three months later, the patient developed recurrence of the same abdominal pain, nausea and vomiting. A diagnosis of acute cholecystitis was made; cholecytostomy was performed as surgery was deemed to be high risk for him given the extension of portal venous thrombosis into the superior mesenteric and splenic veins. Subsequently, anticoagulation with warfarin was initiated. Follow-up MRCP showed significant strictures of the distal common bile duct and intrahepatic duct suggestive of sclerosing cholangitis. It also revealed late hyper-enhancement of soft tissue along the porta hepatis surrounding the right hepatic duct, common hepatic duct, and common bile duct. At this point in clinical course, a diagnosis of portal cavernoma cholangiopathy was entertained and later confirmed with endoscopic doppler ultrasound and treatment initiated. Portal cavernoma cholangiopathy can mimic clinical entities such as: choledocholithiasis, primary sclerosing cholangitis, cholangiocarcinoma, recurrent pyogenic cholangitis, biliary parasitosis, congenital anomalies of biliary tree, AIDS cholangiopathy, and strictures due to autoimmune and chronic pancreatitis. This case is an excellent example of a rare clinical entity requiring high clinical suspicion and recognition of its various presentations to timely diagnosis and appropriate management. None
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.005 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".