Portal cavernoma is a rare and little-known pathology in clinical practice, which can cause difficulties in differential diagnosis with malignant formations of the hepatopancreatobiliary region, in particular, adenocarcinoma of the pancreas. Purpose. We present a clinical case of portal cavernoma in a patient with suspected adenocarcinoma of the pancreatic head. Materials and methods. A 57-year-old man with a medical history of esophageal variceal bleed was admitted for follow-up examination of suspected pancreatic mass, endoscopic ultrasound (EUS) guided biopsy and a decision on surgical treatment. He underwent abdominal contrast-enhanced computed tomography (CT), which demonstrated signs of portal hypertension and chronic portal vein obstruction with formation of a portal cavernoma. Diagnosis was confirmed with EUS. Results and conclusions. Early properly put diagnosis allowed to avoid unreasonable diagnostic and surgical interventions, choose optimal patient surveillance.