GI Radiology > Liver > Others > Budd-Chiari Syndrome

Others

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.
 

© Copyright Rector and Visitors of the University of Virginia 2013