Hepatic veno-occlusive disease (VOD), also known as sinusoidal obstruction syndrome (SOS), is a condition arising from occlusion of hepatic venules.
Toxic injury to liver sinusoids causes sloughing of endothelial cells which embolize to hepatic venules and cause eventual fibrosis of the venules. This results in hepatic congestion (similar to Budd-Chiari syndrome) and post-sinusoidal portal hypertension.
- bone marrow transplantation
- chemotherapy, includes systemic neo-adjuvant chemotherapy in metastatic colorectal cancer, particularly the use of oxaliplatin
- pyrrolizidine alkaloids (Jamaican bush tea)
Imaging modality of choice which may show:
- portal vein abnormalities:
- portal vein dilatation
- portal venous pulsatility
- hepatofugal portal venous flow
- elevated hepatic artery resistive index (> 0.8)
- loss of triphasic hepatic venous flow
- gallbladder wall thickening (> 6-8 mm)
Recent MRI studies with hepatocyte-specific contrast agent show a diffuse hypointense reticular pattern on post-contrast T1 delayed hepatobiliary phase as a highly specific sign for diagnosis.
Treatment and prognosis
There is no standard treatment regimen but options include:
- supportive care
Preoperative planning for hepatic metastasectomy should include exclusion of SOS after use of chemotherapy as there is increased risk of postoperative liver failure.
Approximately half resolve but high mortality in severe cases (up to 90%).
- hepatic failure
- portal hypertension
- 1. Bayraktar UD, Seren S, Bayraktar Y. Hepatic venous outflow obstruction: three similar syndromes. World J. Gastroenterol. 2007;13 (13): 1912-27. Pubmed citation
- 2. Erturk SM, Mortelé KJ, Binkert CA et-al. CT features of hepatic venoocclusive disease and hepatic graft-versus-host disease in patients after hematopoietic stem cell transplantation. AJR Am J Roentgenol. 2006;186 (6): 1497-501. doi:10.2214/AJR.05.0539 - Pubmed citation
- 3. Gastrointestinal Imaging. Oxford University Press. (2015) ISBN:0199759421. Read it at Google Books - Find it at Amazon
- 4. Rubbia-Brandt L, Audard V, Sartoretti P et-al. Severe hepatic sinusoidal obstruction associated with oxaliplatin-based chemotherapy in patients with metastatic colorectal cancer. Ann. Oncol. 2004;15 (3): 460-6. doi:10.1093/annonc/mdh095 - Pubmed citation
- 5. Zorzi D, Laurent A, Pawlik TM et-al. Chemotherapy-associated hepatotoxicity and surgery for colorectal liver metastases. Br J Surg. 2007;94 (3): 274-86. doi:10.1002/bjs.5719 - Pubmed citation