Budd-Chiari syndrome

Background

Posterior abdominal wall, after removal of the peritoneum, showing kidneys, suprarenal capsules, and great vessels. (Hepatic veins labeled at center top.)

• Rare
• Caused by occlusion of hepatic veins, 75% primary (thrombosis), 25% secondary (compression by mass)
• Fulminant, acute, chronic, or asymptomatic.

Clinical Features

• Classic triad:
  1. Abdominal pain
  2. Ascites
  3. Hepatomegaly

Differential Diagnosis

• Hepatitis
• Cirrhosis

Evaluation

Budd–Chiari syndrome secondary to cancer, note clot in the inferior vena cava and the metastasis in the liver.

• LFTs, BMP, LDH
• Ultrasound, retrograde angiography
• CT and MRI less sensitive

Management

• Sodium restriction, diuretics, anticoagulants
• Venous shunts or TIPS
• Liver transplant

See Also

• Portal vein thrombosis