GI Radiology > Liver > Others > Budd-Chiari Syndrome


Budd-Chiari Syndrome

  1. Pathogenesis:
  • Hepatic vein obstruction, usually thrombosis, leading to portal hypertension and ascites.
  • Key: large, tender liver with increased ascites.
  • Mostly idiopathic. Rare causes are hypercoagulable states (e.g., polycythemia vera, malignancy, oral contraceptive use) or local diseases (HCC, pancreatic cancer, or RCC).
  • The caudate lobe is spared because its venous drainage is directly to the IVC.
  1. Radiographic findings:
  • Findings depend on the acuteness or chronicity of the condition.
  • Acute: dramatic decompensation; can go into shock.
  • Chronic: ascites and hepatomegaly. Jaundice is less common.
  • U/S: absent flow in the hepatic veins or IVC; inhomogeneous echoes.
  • CT: hepatosplenomegaly and patchy enhancement (arrows); the caudate lobe may also be enlarged in conditions longer than several weeks and collateral circulation may also be visualized.


  • MRI: decrease in size and number of hepatic veins and visualization of collateral circulation.

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