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Mottled peripheral hypodensity to the right liver, mainly in the periphery of segments V, VI, VII and VIII. Right and middle hepatic veins do not opacify. Left and caudate lobes of the liver have a normal appearance with normal opacification of enlarged left hepatic veins. Portal veins opacify normally. As best as can be determined peripheral right portal vein branches opacify normally. If Hepatic artery not well seen secondary to timing of CT. Splenomegaly.
Adrenal glands, kidney and pancreas have a normal appearance. Cholecystectomy noted. No free fluid or free gas. Bilateral pleural effusions, larger on the left. Minor bibasal atelectasis.
Appearances are of right liver hypoperfusion, probably from venous congestion from right and middle hepatic vein complete thrombosis. This represents Budd-Chiari syndrome.