Budd-Chiari syndrome

Case contributed by Dr Henry Knipe

Presentation

Upper abdominal pain. JAK negative essential thrombocytopaenia.

Patient Data

Age: 35
Gender: Female
CT

Upper abdomen

Mottled peripheral hypodensity to the right liver, mainly in the periphery of segments V, VI, VII and VIII. The right and middle hepatic veins do not opacify. The left and caudate lobes of the liver have a normal appearance with normal opacification of enlarged left hepatic veins. The portal veins opacify normally. As best as can be determined the peripheral right portal vein branches opacify normally. The hepatic artery is not well seen secondary to timing of the CT. Splenomegaly.

Cholecystectomy. Adrenal glands, kidney and pancreas have a normal appearance. No free fluid or free gas.

Bilateral pleural effusions, larger on the left. Minor bibasal atelectasis.

Conclusion:

Appearances are of right liver hypoperfusion, probably from venous congestion from right and middle hepatic vein complete thrombosis. This represents Budd-Chiari syndrome. 

Case Discussion

Ultrasound confirmed the presence of occlusive thrombus within the right and middle hepatic veins in keeping with Budd-Chiari syndrome. Normal flow direction in the portal veins. 

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Case information

rID: 27929
Case created: 27th Feb 2014
Last edited: 24th May 2017
Inclusion in quiz mode: Included

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