eMedicine Specialties > Gastroenterology > Liver

Budd-Chiari Syndrome: Differential Diagnoses & Workup

Author: Praveen K Roy, MD, Comments and Criticisms Editor, Cochrane Colorectal Cancer Group
Coauthor(s): Abhishek Choudhary, MD, Resident, Department of Internal Medicine, University Hospital of Missouri; Homayoun Shojamanesh, MD, Former Fellow, Digestive Diseases Branch, National Institutes of Health; Jack Bragg, DO, FACOI, Assistant Professor, Department of Clinical Medicine, University of Missouri School of Medicine; Gautam Dehadrai, MD, Department Chair, Section Chief, Department of Interventional Radiology, Norman Regional Hospital
Contributor Information and Disclosures

Updated: Sep 9, 2008

Differential Diagnoses

Pericarditis, Constrictive

Other Problems to Be Considered

Right-sided heart failure
Metastatic liver disease
Alcoholic liver disease
Granulomatous liver disease

Workup

Laboratory Studies

  • Examination of ascitic fluid provides useful clues to the diagnosis.
    • Patients usually have high protein concentrations (>2 g/dL). This may not be present in persons with the acute form of Budd-Chiari syndrome.
    • The WBC count is usually less than 500/µL.
    • The serum ascites–albumin gradient is usually less than 1.1 (except in the acute forms of the disease).
  • Routine biochemical test results are usually nonspecific. Mild elevations in serum aminotransferase and alkaline phosphatase levels are present in 25-50% of patients.
  • Hematological studies should be performed to evaluate for a hypercoagulable state.
  • See Polycythemia Vera; Thrombocytosis, Essential; Protein C Deficiency; Protein S Deficiency; and Myeloproliferative Disease for more information.

Imaging Studies

  • Ultrasound
    • Thrombi can be visualized.
    • Color-flow Doppler ultrasound is the preferred mode. Sensitivity and specificity are 85-90%.
  • Magnetic resonance imaging (MRI) scanning with pulsed sequencing
    • MRI images help in the assessment of hepatic venous blood flow.
    • Sensitivity and specificity are 90%.
  • Hepatic venography
    • Thrombi are observed in hepatic veins.
    • With venography, hepatic vein orifices cannot be cannulated.

Procedures

  • Liver biopsy

Histologic Findings

Pathological findings after liver biopsy are (1) high-grade venous congestion and centrilobular liver cell atrophy, and, possibly, (2) thrombi within the terminal hepatic venules. The extent of fibrosis can be determined based on biopsy findings.

More on Budd-Chiari Syndrome

Overview: Budd-Chiari Syndrome
Differential Diagnoses & Workup: Budd-Chiari Syndrome
Treatment & Medication: Budd-Chiari Syndrome
Follow-up: Budd-Chiari Syndrome
References
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References

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Further Reading

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Keywords

Budd-Chiari syndrome, hepatic vein occlusion, hepatic vein obstruction, hepatic obstruction, liver obstruction, liver disease, hepatic disease, thrombotic hepatic vein obstruction, nonthrombotic hepatic vein obstruction, non-thrombotic hepatic vein obstruction, obliterating hepatic vein endophlebitis, hepatomegaly, ascites, thrombotic diathesis, congestive hepatopathy, hepatic congestion, liver congestion, membranous webs, acute liver disease, subacute liver disease, fulminant liver disease, liver failure

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Contributor Information and Disclosures

Author

Praveen K Roy, MD, Comments and Criticisms Editor, Cochrane Colorectal Cancer Group
Praveen K Roy, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, and Canadian Association of Gastroenterology
Disclosure: Nothing to disclose.

Coauthor(s)

Abhishek Choudhary, MD, Resident, Department of Internal Medicine, University Hospital of Missouri
Abhishek Choudhary, MD is a member of the following medical societies: American College of Physicians
Disclosure: Nothing to disclose.

Homayoun Shojamanesh, MD, Former Fellow, Digestive Diseases Branch, National Institutes of Health
Homayoun Shojamanesh, MD is a member of the following medical societies: American Gastroenterological Association, American Medical Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Jack Bragg, DO, FACOI, Assistant Professor, Department of Clinical Medicine, University of Missouri School of Medicine
Jack Bragg, DO, FACOI is a member of the following medical societies: American College of Osteopathic Internists and American Osteopathic Association
Disclosure: Nothing to disclose.

Gautam Dehadrai, MD, Department Chair, Section Chief, Department of Interventional Radiology, Norman Regional Hospital
Gautam Dehadrai, MD is a member of the following medical societies: American College of Radiology, Medical Council of India, and Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

Robert J Fingerote, MD, MSc, BSc, FRCPC, Consultant, Clinical Evaluation Division, Biologic and Gene Therapies, Directorate Health Canada; Consulting Staff, Department of Medicine, Division of Gastroenterology, York Central Hospital, Richmond Hill, Ontario
Robert J Fingerote, MD, MSc, BSc, FRCPC is a member of the following medical societies: American Association for the Study of Liver Diseases, American Gastroenterological Association, Canadian Medical Association, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

James L Achord, MD, Professor Emeritus, Department of Medicine, Division of Digestive Diseases, University of Mississippi School of Medicine
James L Achord, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Mississippi State Medical Association, New York Academy of Sciences, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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