Budd-Chiari syndrome

Case contributed by Michael P Hartung
Diagnosis certain


Abdominal distention and discomfort for several months.

Patient Data

Age: 40 years
Gender: Female

Small loculated right and medium left pleural effusions. 

Nutmeg liver with early cirrhotic changes. Normal size right heart. Occluded intrahepatic segment of the IVC and hepatic veins, which are relatively small in caliber. Large ascites. 

Case Discussion

Striking case of Budd-Chiari syndrome with a late presentation due to several months of symptoms, resulting in relatively small caliber (but occluded) hepatic veins and intrahepatic segment of the IVC. Accounting for the nutmeg perfusion is key in making this diagnosis, as your major other consideration would be right heart disease. The right heart size is normal, and thus careful interrogation of the vasculature can lead you to this diagnosis. 

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