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A 38-year-old woman, diagnosed with portal hypertension 8 months back, presented with painless jaundice. Her synthetic liver function was normal and serology was negative for hepatitis virus. Liver function tests showed total serum bilirubin 321 mmol/l, serum alanine aminotransferase 59 IU/l, aspartate aminotransferase 80 IU/l, γ-glutamyltransferase 114 IU/l and serum alkaline phosphatase 296 IU/l. CT of the abdomen showed hepatosplenomegaly, ascites and intrahepatic and extrahepatic biliary ductal dilatation (figure 1). The common bile duct showed smooth tapering distally without any mass. The main portal vein was replaced by a large cavernoma and multiple collaterals were seen at systemic-portal sites. This portal cavernoma …
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