Budd-Chiari syndrome

Case contributed by Dr Henry Knipe


Upper abdominal pain. JAK negative essential thrombocytopaenia.

Patient Data

Age: 35
Gender: Female

Upper abdomen

Modality: CT

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. 

Case Discussion

Ultrasound confirms 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: 30th Aug 2015
Inclusion in quiz mode: Included

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