Presentation
Abdominal pain (increasing), with ascites, and mild splenomegaly.
Patient Data
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Mottled nodular appearance of liver is seen with some peripheral enhancement in nodules on delayed imaging. Multiple subcapsular and hockey-stick shaped collaterals are seen arising from suprahepatic inferior vena cava, along superior and posterior surfaces of liver. Normal branching of hepatic vein is not seen, rather a longitudinal thin partition/web is seen in suprahepatic inferior venacava, extending upto anatomical level of origin of hepatic veins. Associated ascites and splenomegaly is seen, with prominent portal vein. Caudate lobe enlargement is also marked.
Case Discussion
Membranous Budd-Chiari syndrome due to 'web' in inferior vena cava is a rare entity, with better prognosis than thrombotic Budd-Chiari syndrome. This patient has compensated cirrhotic features, with relatively normalized liver function test parameters except hypoalbuminemia. Planning of resection of IVC membrane is being done.
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