Presentation
Diffuse abdominal pain and distension.
Patient Data
Mildly enlarged cirrhotic liver with heterogenous hypoattenuation and patchy enhancement. The hepatic vein are not seen and the intrahepatic segment of the inferior vena cava is attenuated. Recanalization of the paraumbilical vein.
Marked ascites.
Small left pleural effusion.
Moderate soft tissue edema in the abdominal walls.
Cholelithiasis.
Wall thickening versus underdistention of the stomach and proximal small bowel loops which may be due to portal gastroenteropathy.
Case Discussion
Findings are consistent with Budd-Chiari syndrome with marked ascites, a small left pleural effusion, and generalized anasarca.
The caudate lobe is not hypertrophied in this patient, and the amount of ascites has significantly increased since the prior examination performed one week earlier (not shown). These findings suggest acute rather than chronic Budd-Chiari syndrome.