Budd-Chiari syndrome

Case contributed by Dalia Ibrahim
Diagnosis almost certain


The patient had a history of post-partum complications, followed by recurrent marked abdominal ascites.

Patient Data

Age: 35 years
Gender: Female

The liver is enlarged showing a markedly enlarged caudate lobe. It shows early enhancement of the caudate lobe and central liver around the IVC with delayed enhancement of the liver periphery. Occluded all hepatic veins and stenotic intra-hepatic segment of the IVC. Hepatic dome segment VIII small enhancing lesion with no contrast wash out likely regeneration nodule.

Marked abdominal and pelvic ascites.

Umbilical hernia containing ascitic fluid.

Calcular gallbladder.

Marked right pleural effusion with underlying relaxation collapse of the right lung lobes.

Case Discussion

Budd Chiari syndrome occurs when there's partial or complete obstruction of the hepatic veins.

Typical radiological features include:

  • hypertrophy of the caudate lobe
  • early enhancement of the caudate lobe and central liver around IVC
  • delayed enhancement of the liver periphery with low-density center (Flip-flop appearance)
  • regenerative nodules
  • inability to identify hepatic veins

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