eMedicine Specialties > Radiology > Gastrointestinal

Budd-Chiari Syndrome: Multimedia

Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, Consultant Radiologist, North Manchester General Hospital, The Pennine Acute NHS Trust, Manchester UK
Coauthor(s): Muthusamy Chandramohan, MBBS, DMRD, FRCR, Consultant Radiologist, Bradford Teaching Hospitals, UK; Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Contributor Information and Disclosures

Updated: Jan 22, 2009

Multimedia

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Media file 1: Diagram of hepatic venous drainage depicts the small veins that drain from the caudate lobe and adjacent part of the right lobe directly into the inferior vena cava. The veins tend to be spared in hepatic venous occlusion in patients with Budd-Chiari syndrome, giving rise to hypertrophy of the caudate lobe and adjacent part of the right lobe.

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Diagram of hepatic venous drainage depicts the small veins that drain from the caudate lobe and adjacent part of the right lobe directly into the inferior vena cava. The veins tend to be spared in hepatic venous occlusion in patients with Budd-Chiari syndrome, giving rise to hypertrophy of the caudate lobe and adjacent part of the right lobe.

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Media file 2: Inferior venacavogram shows compression and lateral displacement of the inferior vena cava by an enlarged caudate lobe.

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Inferior venacavogram shows compression and lateral displacement of the inferior vena cava by an enlarged caudate lobe.

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Media file 3: Wedged hepatic venogram shows a coarse-mesh spiderweb pattern resulting from an intrahepatic network of collateral vessels.

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Wedged hepatic venogram shows a coarse-mesh spiderweb pattern resulting from an intrahepatic network of collateral vessels.

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Media file 4: Inferior venacavogram shows an upper inferior vena cava stenosis with reflux of the contrast into the hepatic venous circulation due to partial obstruction of the distal inferior vena cava.

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Inferior venacavogram shows an upper inferior vena cava stenosis with reflux of the contrast into the hepatic venous circulation due to partial obstruction of the distal inferior vena cava.

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Media file 5: Following placement of a wall stent in the upper inferior vena cava, a wide patency of the inferior vena cava is seen (same patient as in Image 6). Note the lack of reflux of contrast into the hepatic veins.

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Following placement of a wall stent in the upper inferior vena cava, a wide patency of the inferior vena cava is seen (same patient as in Image 6). Note the lack of reflux of contrast into the hepatic veins.

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Media file 6: A 53-year-old man presented with nonspecific symptoms and a mild swelling of the legs. He had no features of heart failure. Abdominal B-mode sonogram shows a distended inferior vena cava with intraluminal filling defects suggestive of a thrombus within the inferior vena cava. On a thorough search, no hepatic veins were identified, but the liver presented a heterogeneous echo pattern, although no discrete mass was identified.

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A 53-year-old man presented with nonspecific symptoms and a mild swelling of the legs. He had no features of heart failure. Abdominal B-mode sonogram shows a distended inferior vena cava with intraluminal filling defects suggestive of a thrombus within the inferior vena cava. On a thorough search, no hepatic veins were identified, but the liver presented a heterogeneous echo pattern, although no discrete mass was identified.

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Media file 7: Technetium-99m sulfur colloid scan in a 53-year-old man who presented with nonspecific symptoms and a mild swelling of the legs. The patient had no features of heart failure (same patient as in Images 8-9). Scan shows patchy radionuclide uptake in most of the liver but intense activity in the region of the caudate lobe. Analysis of a sample from percutaneous liver biopsy revealed histologic features of Budd-Chiari syndrome.

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Technetium-99m sulfur colloid scan in a 53-year-old man who presented with nonspecific symptoms and a mild swelling of the legs. The patient had no features of heart failure (same patient as in Images 8-9). Scan shows patchy radionuclide uptake in most of the liver but intense activity in the region of the caudate lobe. Analysis of a sample from percutaneous liver biopsy revealed histologic features of Budd-Chiari syndrome.

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Media file 8: A 42-year-old man presented with an intractable ascites of unknown cause before CT scanning and gray-scale ultrasonography were available. The patient had repeated juguloperitoneal shunt placements for relief of the ascites. The ascites diminished, but the patient experienced persistent vague abdominal symptoms. At one stage, the symptoms were urological, and an intravenous urogram was performed, which shows right hydronephrosis and displacement of the right lower ureter and bladder to the right. Note the unusual linear calcification in the right upper quadrant. Many years after the initial symptoms appeared, imaging techniques had advanced (see Images 12-19).

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A 42-year-old man presented with an intractable ascites of unknown cause before CT scanning and gray-scale ultrasonography were available. The patient had repeated juguloperitoneal shunt placements for relief of the ascites. The ascites diminished, but the patient experienced persistent vague abdominal symptoms. At one stage, the symptoms were urological, and an intravenous urogram was performed, which shows right hydronephrosis and displacement of the right lower ureter and bladder to the right. Note the unusual linear calcification in the right upper quadrant. Many years after the initial symptoms appeared, imaging techniques had advanced (see Images 12-19).

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Media file 9: A 42-year-old man presented with an intractable ascites of unknown cause many years ago. At the time, the patient had repeated juguloperitoneal shunt placements for relief of the ascites. The ascites diminished, but the patient experienced persistent vague abdominal symptoms. When imaging techniques evolved, sagittal ultrasound was performed in the patient's liver and shows 2 hepatic veins, which appeared pruned, with no ramifications (same patient as in Images 11-19).

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A 42-year-old man presented with an intractable ascites of unknown cause many years ago. At the time, the patient had repeated juguloperitoneal shunt placements for relief of the ascites. The ascites diminished, but the patient experienced persistent vague abdominal symptoms. When imaging techniques evolved, sagittal ultrasound was performed in the patient's liver and shows 2 hepatic veins, which appeared pruned, with no ramifications (same patient as in Images 11-19).

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Media file 10: A 42-year-old man presented with an intractable ascites of unknown cause many years ago. At the time, the patient had repeated juguloperitoneal shunt placements for relief of the ascites. The ascites diminished, but the patient experienced persistent vague abdominal symptoms. When imaging techniques evolved, a contrast-enhanced CT scan of the upper abdomen was performed and shows extensive liver/splenic capsular and peritoneal calcification and patchy attenuation within the liver. The left lobe/caudate lobe appears hypertrophied (same patient as in Images 11-16).

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A 42-year-old man presented with an intractable ascites of unknown cause many years ago. At the time, the patient had repeated juguloperitoneal shunt placements for relief of the ascites. The ascites diminished, but the patient experienced persistent vague abdominal symptoms. When imaging techniques evolved, a contrast-enhanced CT scan of the upper abdomen was performed and shows extensive liver/splenic capsular and peritoneal calcification and patchy attenuation within the liver. The left lobe/caudate lobe appears hypertrophied (same patient as in Images 11-16).

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Media file 11: A 42-year-old man presented with an intractable ascites of unknown cause many years ago. At the time, the patient had repeated juguloperitoneal shunt placements for relief of the ascites. The ascites diminished, but the patient experienced persistent vague abdominal symptoms. When imaging techniques evolved, unenhanced CT scan was performed and shows splenomegaly and a small ascites medial to the spleen (arrow) (same patient as in Images 11-16).

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A 42-year-old man presented with an intractable ascites of unknown cause many years ago. At the time, the patient had repeated juguloperitoneal shunt placements for relief of the ascites. The ascites diminished, but the patient experienced persistent vague abdominal symptoms. When imaging techniques evolved, unenhanced CT scan was performed and shows splenomegaly and a small ascites medial to the spleen (arrow) (same patient as in Images 11-16).

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Media file 12: A 42-year-old man presented with an intractable ascites of unknown cause many years ago. At the time, the patient had repeated juguloperitoneal shunt placements for relief of the ascites. The ascites diminished, but the patient experienced persistent vague abdominal symptoms. When imaging techniques evolved, unenhanced CT scan of the pelvis was performed and shows a loculated ascites, which was responsible for the displaced bladder and right ureter as seen in Image 11 (same patient as in Images 11-16).

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A 42-year-old man presented with an intractable ascites of unknown cause many years ago. At the time, the patient had repeated juguloperitoneal shunt placements for relief of the ascites. The ascites diminished, but the patient experienced persistent vague abdominal symptoms. When imaging techniques evolved, unenhanced CT scan of the pelvis was performed and shows a loculated ascites, which was responsible for the displaced bladder and right ureter as seen in Image 11 (same patient as in Images 11-16).

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Media file 13: A 42-year-old man presented with an intractable ascites of unknown cause many years ago. At the time, the patient had repeated juguloperitoneal shunt placements for relief of the ascites. The ascites diminished, but the patient experienced persistent vague abdominal symptoms. When imaging techniques evolved, T1-weighted axial MRI was performed through the liver and shows a low signal within the right liver (same patient as in Images 11-16). The left lobe/caudate lobe is hypertrophied. Note the misshapen inferior vena cava.

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A 42-year-old man presented with an intractable ascites of unknown cause many years ago. At the time, the patient had repeated juguloperitoneal shunt placements for relief of the ascites. The ascites diminished, but the patient experienced persistent vague abdominal symptoms. When imaging techniques evolved, T1-weighted axial MRI was performed through the liver and shows a low signal within the right liver (same patient as in Images 11-16). The left lobe/caudate lobe is hypertrophied. Note the misshapen inferior vena cava.

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Media file 14: A 42-year-old man presented with an intractable ascites of unknown cause many years ago. At the time, the patient had repeated juguloperitoneal shunt placements for relief of the ascites. The ascites diminished, but the patient experienced persistent vague abdominal symptoms. When imaging techniques evolved, T2-weighted axial MRI was performed through the liver and shows a high signal within the right liver (same patient as in Images 11-16). The left lobe/caudate lobe is hypertrophied. Note the misshapen inferior vena cava.

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A 42-year-old man presented with an intractable ascites of unknown cause many years ago. At the time, the patient had repeated juguloperitoneal shunt placements for relief of the ascites. The ascites diminished, but the patient experienced persistent vague abdominal symptoms. When imaging techniques evolved, T2-weighted axial MRI was performed through the liver and shows a high signal within the right liver (same patient as in Images 11-16). The left lobe/caudate lobe is hypertrophied. Note the misshapen inferior vena cava.

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Media file 15: A 42-year-old man presented with an intractable ascites of unknown cause many years ago. At the time, the patient had repeated juguloperitoneal shunt placements for relief of the ascites. The ascites diminished, but the patient experienced persistent vague abdominal symptoms. When imaging techniques evolved, axial short-tau inversion recovery MRI was performed through the liver and shows a high signal (edema) within the right liver (same patient as in Images 11-16). The left lobe/caudate lobe is hypertrophied. Note the misshapen inferior vena cava.

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A 42-year-old man presented with an intractable ascites of unknown cause many years ago. At the time, the patient had repeated juguloperitoneal shunt placements for relief of the ascites. The ascites diminished, but the patient experienced persistent vague abdominal symptoms. When imaging techniques evolved, axial short-tau inversion recovery MRI was performed through the liver and shows a high signal (edema) within the right liver (same patient as in Images 11-16). The left lobe/caudate lobe is hypertrophied. Note the misshapen inferior vena cava.

(Enlarge Image)

Media file 16: A 42-year-old man presented with an intractable ascites of unknown cause many years ago. At the time, the patient had repeated juguloperitoneal shunt placements for relief of the ascites. The ascites diminished, but the patient experienced persistent vague abdominal symptoms. When imaging techniques evolved, a wedged hepatic venogram was performed and shows a fine-mesh spiderweb pattern resulting from an intrahepatic network of collateral vessels (same patient as in Images 11-16). At this stage, direct questioning elicited that the patient had been accidentally exposed to radiation in the late 1950s. Analysis of a biopsy specimen confirmed Budd-Chiari syndrome. The cause of the capsular/peritoneal calcification could not be determined, but 2 factors may have been the cause: radiation damage or the repeated placement of jugular peritoneal shunts.

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A 42-year-old man presented with an intractable ascites of unknown cause many years ago. At the time, the patient had repeated juguloperitoneal shunt placements for relief of the ascites. The ascites diminished, but the patient experienced persistent vague abdominal symptoms. When imaging techniques evolved, a wedged hepatic venogram was performed and shows a fine-mesh spiderweb pattern resulting from an intrahepatic network of collateral vessels (same patient as in Images 11-16). At this stage, direct questioning elicited that the patient had been accidentally exposed to radiation in the late 1950s. Analysis of a biopsy specimen confirmed Budd-Chiari syndrome. The cause of the capsular/peritoneal calcification could not be determined, but 2 factors may have been the cause: radiation damage or the repeated placement of jugular peritoneal shunts.

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Media file 17: Budd-Chiari syndrome: Two ultrasound images (see below) from a 13-year old boy who presented with jaundice, abdominal distention, and features of hepatic encephalopathy and sepsis. Ultrasound showed bilateral pleural effusions, ascites, and no flow within the hepatic veins but a patent IVC.

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Budd-Chiari syndrome: Two ultrasound images (see below) from a 13-year old boy who presented with jaundice, abdominal distention, and features of hepatic encephalopathy and sepsis. Ultrasound showed bilateral pleural effusions, ascites, and no flow within the hepatic veins but a patent IVC.

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Media file 18: Budd-Chiari syndrome: Two ultrasound images (see above) from a 13-year old boy that presented with jaundice, abdominal distention, and features of hepatic encephalopathy and sepsis. Ultrasound showed bilateral pleural effusions, ascites, and no flow within the hepatic veins but a patent IVC.

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Budd-Chiari syndrome: Two ultrasound images (see above) from a 13-year old boy that presented with jaundice, abdominal distention, and features of hepatic encephalopathy and sepsis. Ultrasound showed bilateral pleural effusions, ascites, and no flow within the hepatic veins but a patent IVC.

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Media file 19: Budd-Chiari syndrome: Six ultrasound images (see Images below) of a 28-year-old female who presented with a nonspecific illness and abnormal liver function tests. The ultrasound scans show no flow in hepatic veins, compressed IVC, enlarged caudate lobe, splenomegaly, and varices at the splenic hilum.

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Budd-Chiari syndrome: Six ultrasound images (see Images below) of a 28-year-old female who presented with a nonspecific illness and abnormal liver function tests. The ultrasound scans show no flow in hepatic veins, compressed IVC, enlarged caudate lobe, splenomegaly, and varices at the splenic hilum.

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Media file 20: Budd-Chiari syndrome: Six ultrasound images of a 28-year-old female who presented with a nonspecific illness and abnormal liver function tests. The ultrasound scans show no flow in hepatic veins, compressed IVC, enlarged caudate lobe, splenomegaly, and varices at the splenic hilum.

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Budd-Chiari syndrome: Six ultrasound images of a 28-year-old female who presented with a nonspecific illness and abnormal liver function tests. The ultrasound scans show no flow in hepatic veins, compressed IVC, enlarged caudate lobe, splenomegaly, and varices at the splenic hilum.

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Media file 21: Budd-Chiari syndrome: Six ultrasound images of a 28-year-old female that presented who a nonspecific illness and abnormal liver function tests. The ultrasound scans show no flow in hepatic veins, compressed IVC, enlarged caudate lobe, splenomegaly, and varices at the splenic hilum.

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Budd-Chiari syndrome: Six ultrasound images of a 28-year-old female that presented who a nonspecific illness and abnormal liver function tests. The ultrasound scans show no flow in hepatic veins, compressed IVC, enlarged caudate lobe, splenomegaly, and varices at the splenic hilum.

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Media file 22: Budd-Chiari syndrome: Six ultrasound images of a 28-year-old female who presented with a nonspecific illness and abnormal liver function tests. The ultrasound scans show no flow in hepatic veins, compressed IVC, enlarged caudate lobe, splenomegaly, and varices at the splenic hilum.

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Budd-Chiari syndrome: Six ultrasound images of a 28-year-old female who presented with a nonspecific illness and abnormal liver function tests. The ultrasound scans show no flow in hepatic veins, compressed IVC, enlarged caudate lobe, splenomegaly, and varices at the splenic hilum.

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Media file 23: Budd Chiari Syndrome: Six Ultrasound images on a 28-year old female that presented with a non-specific illness and abnormal liver function tests. The Ultrasound scans show no flow in hepatic veins, compressed IVC, enlarged caudate lobe, splenomegaly and varices at the splenic hilum.

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Budd Chiari Syndrome: Six Ultrasound images on a 28-year old female that presented with a non-specific illness and abnormal liver function tests. The Ultrasound scans show no flow in hepatic veins, compressed IVC, enlarged caudate lobe, splenomegaly and varices at the splenic hilum.

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Media file 24: Budd-Chiari syndrome: Six ultrasound images of a 28-year-old female who presented with a nonspecific illness and abnormal liver function tests. The ultrasound scans show no flow in hepatic veins, compressed IVC, enlarged caudate lobe, splenomegaly, and varices at the splenic hilum.

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Budd-Chiari syndrome: Six ultrasound images of a 28-year-old female who presented with a nonspecific illness and abnormal liver function tests. The ultrasound scans show no flow in hepatic veins, compressed IVC, enlarged caudate lobe, splenomegaly, and varices at the splenic hilum.

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Media file 25: Budd-Chiari syndrome: Contrast-enhanced axial CT scan showing a large ascites, patchy enhancement of the liver, an enlarged caudate lobe, attenuated hepatic veins, hepatic vein–portal vein shunts, and a thrombus within the intrahepatic IVC.

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Budd-Chiari syndrome: Contrast-enhanced axial CT scan showing a large ascites, patchy enhancement of the liver, an enlarged caudate lobe, attenuated hepatic veins, hepatic vein–portal vein shunts, and a thrombus within the intrahepatic IVC.

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Media file 26: Budd-Chiari syndrome: Contrast-enhanced axial CT scan showing a large ascites, patchy enhancement of the liver, an enlarged caudate lobe, attenuated hepatic veins, hepatic vein–portal vein shunts, and a thrombus within the intrahepatic IVC.

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Budd-Chiari syndrome: Contrast-enhanced axial CT scan showing a large ascites, patchy enhancement of the liver, an enlarged caudate lobe, attenuated hepatic veins, hepatic vein–portal vein shunts, and a thrombus within the intrahepatic IVC.

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Media file 27: Budd-Chiari syndrome: Contrast-enhanced axial CT scan showing a large ascites, patchy enhancement of the liver, an enlarged caudate lobe, attenuated hepatic veins, hepatic vein–portal vein shunts, and a thrombus within the intrahepatic IVC.

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Budd-Chiari syndrome: Contrast-enhanced axial CT scan showing a large ascites, patchy enhancement of the liver, an enlarged caudate lobe, attenuated hepatic veins, hepatic vein–portal vein shunts, and a thrombus within the intrahepatic IVC.

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Media file 28: Acute Budd-Chiari syndrome with recovery. A 36-year-old female patient with known Behcet's disease presented with abdominal distention, leg edema, and abnormal liver function tests. Nonenhanced in-phase T2WI shows heterogeneity of the liver parenchyma. Note the thrombus in the IVC and the ascites.

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Acute Budd-Chiari syndrome with recovery. A 36-year-old female patient with known Behcet's disease presented with abdominal distention, leg edema, and abnormal liver function tests. Nonenhanced in-phase T2WI shows heterogeneity of the liver parenchyma. Note the thrombus in the IVC and the ascites.

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Media file 29: Acute Budd-Chiari syndrome with recovery. A 36-year-old female patient with known Behcet's disease presented with abdominal distention, leg edema, and abnormal liver function tests. Nonenhanced in-phase T2WI shows heterogeneity of the liver parenchyma. Note the thrombus in the IVC and the ascites.

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Acute Budd-Chiari syndrome with recovery. A 36-year-old female patient with known Behcet's disease presented with abdominal distention, leg edema, and abnormal liver function tests. Nonenhanced in-phase T2WI shows heterogeneity of the liver parenchyma. Note the thrombus in the IVC and the ascites.

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Media file 30: Acute Budd-Chiari syndrome with recovery. A 36-year-old female patient with known Behcet's disease presented with abdominal distention, leg edema, and abnormal liver function tests. Nonenhanced in-phase T2WI shows heterogeneity of the liver parenchyma. Note the thrombus in the IVC and the ascites.

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Acute Budd-Chiari syndrome with recovery. A 36-year-old female patient with known Behcet's disease presented with abdominal distention, leg edema, and abnormal liver function tests. Nonenhanced in-phase T2WI shows heterogeneity of the liver parenchyma. Note the thrombus in the IVC and the ascites.

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Media file 31: Acute Budd-Chiari syndrome with recovery. A 36-year-old female patient with known Behcet's disease presented with abdominal distention, leg edema, and abnormal liver function tests. Nonenhanced in-phase T2WI shows heterogeneity of the liver parenchyma. Note the thrombus in the IVC and the ascites.

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Acute Budd-Chiari syndrome with recovery. A 36-year-old female patient with known Behcet's disease presented with abdominal distention, leg edema, and abnormal liver function tests. Nonenhanced in-phase T2WI shows heterogeneity of the liver parenchyma. Note the thrombus in the IVC and the ascites.

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Media file 32: Gadolinium-enhanced out-of-phase T2WIs demonstrate the inhomogeneous perfusion of the liver, which is characteristic of the disease. The IVC thrombosis is extending to the right renal vein.

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Gadolinium-enhanced out-of-phase T2WIs demonstrate the inhomogeneous perfusion of the liver, which is characteristic of the disease. The IVC thrombosis is extending to the right renal vein.

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Media file 33: Gadolinium-enhanced out-of-phase T2WIs demonstrate the inhomogeneous perfusion of the liver, which is characteristic of the disease. The IVC thrombosis is extending to the right renal vein.

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Gadolinium-enhanced out-of-phase T2WIs demonstrate the inhomogeneous perfusion of the liver, which is characteristic of the disease. The IVC thrombosis is extending to the right renal vein.

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Media file 34: Gadolinium-enhanced out-of-phase T2WIs demonstrate the inhomogeneous perfusion of the liver, which is characteristic of the disease. The IVC thrombosis is extending to the right renal vein.

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Gadolinium-enhanced out-of-phase T2WIs demonstrate the inhomogeneous perfusion of the liver, which is characteristic of the disease. The IVC thrombosis is extending to the right renal vein.

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Media file 35: Post-gadolinium in-phase T2WI shows the attenuation of the hepatic veins with the typical late peripheral enhancement of the liver.

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Post-gadolinium in-phase T2WI shows the attenuation of the hepatic veins with the typical late peripheral enhancement of the liver.

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Media file 36: Post-gadolinium in-phase T1WI showing the hypertrophied caudate lobe compressing the intra-hepatic IVC

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Post-gadolinium in-phase T1WI showing the hypertrophied caudate lobe compressing the intra-hepatic IVC

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Media file 37: Follow-up T2WI scans 10 months later, showing homogeneous liver parenchyma and partial recanalization of the IVC. The caudate lobe is almost back to its normal size, and the compression on the IVC is significantly reduced. The ascites is no longer seen.

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Follow-up T2WI scans 10 months later, showing homogeneous liver parenchyma and partial recanalization of the IVC. The caudate lobe is almost back to its normal size, and the compression on the IVC is significantly reduced. The ascites is no longer seen.

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Media file 38: Follow-up T2WI scans 10 months later, showing homogeneous liver parenchyma and partial recanalization of the IVC. The caudate lobe is almost back to its normal size, and the compression on the IVC is significantly reduced. The ascites is no longer seen.

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Follow-up T2WI scans 10 months later, showing homogeneous liver parenchyma and partial recanalization of the IVC. The caudate lobe is almost back to its normal size, and the compression on the IVC is significantly reduced. The ascites is no longer seen.

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Media file 39: Follow-up T2WI scans 10 months later, showing homogeneous liver parenchyma and partial recanalization of the IVC. The caudate lobe is almost back to its normal size, and the compression on the IVC is significantly reduced. The ascites is no longer seen.

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Follow-up T2WI scans 10 months later, showing homogeneous liver parenchyma and partial recanalization of the IVC. The caudate lobe is almost back to its normal size, and the compression on the IVC is significantly reduced. The ascites is no longer seen.

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Media file 40: Follow-up T2WI scans 10 months later, showing homogeneous liver parenchyma and partial recanalization of the IVC. The caudate lobe is almost back to its normal size, and the compression on the IVC is significantly reduced. The ascites is no longer seen.

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Follow-up T2WI scans 10 months later, showing homogeneous liver parenchyma and partial recanalization of the IVC. The caudate lobe is almost back to its normal size, and the compression on the IVC is significantly reduced. The ascites is no longer seen.

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Media file 41: Follow-up T2WI scans 10 months later, showing homogeneous liver parenchyma and partial recanalization of the IVC. The caudate lobe is almost back to its normal size, and the compression on the IVC is significantly reduced. The ascites is no longer seen.

[ CLOSE WINDOW ]

Follow-up T2WI scans 10 months later, showing homogeneous liver parenchyma and partial recanalization of the IVC. The caudate lobe is almost back to its normal size, and the compression on the IVC is significantly reduced. The ascites is no longer seen.

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Media file 42: Budd-Chiari syndrome. Technetium-99M sulfur colloid scan of the liver shows peripheral areas diminished uptake due to liver atrophy and intense activity in the caudate lobe due to hypertrophy in a patient with BCS.

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Budd-Chiari syndrome. Technetium-99M sulfur colloid scan of the liver shows peripheral areas diminished uptake due to liver atrophy and intense activity in the caudate lobe due to hypertrophy in a patient with BCS.

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Media file 43: Conventional wedged hepatic venogram showing absence of the right hepatic vein and a spiderweb pattern of collaterals and recanalized veins.

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Conventional wedged hepatic venogram showing absence of the right hepatic vein and a spiderweb pattern of collaterals and recanalized veins.

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Media file 44: A 26-year-old man with known Budd-Chiari syndrome palliated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure. He had 2 revisions following hepatic vein angioplasty. The images provided are procedural and contrast-enhanced CT scans following the TIPS procedure. Note the inhomogeneous enhancement, mimicking metastases.

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A 26-year-old man with known Budd-Chiari syndrome palliated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure. He had 2 revisions following hepatic vein angioplasty. The images provided are procedural and contrast-enhanced CT scans following the TIPS procedure. Note the inhomogeneous enhancement, mimicking metastases.

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Media file 45: A 26-year-old man with known Budd-Chiari syndrome palliated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure. He had 2 revisions following hepatic vein angioplasty. The images provided are procedural and contrast-enhanced CT scans following the TIPS procedure. Note the inhomogeneous enhancement, mimicking metastases.

[ CLOSE WINDOW ]

A 26-year-old man with known Budd-Chiari syndrome palliated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure. He had 2 revisions following hepatic vein angioplasty. The images provided are procedural and contrast-enhanced CT scans following the TIPS procedure. Note the inhomogeneous enhancement, mimicking metastases.

(Enlarge Image)

Media file 46: A 26-year-old man with known Budd-Chiari syndrome palliated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure. He had 2 revisions following hepatic vein angioplasty. The images provided are procedural and contrast-enhanced CT scans following the TIPS procedure. Note the inhomogeneous enhancement, mimicking metastases.

[ CLOSE WINDOW ]

A 26-year-old man with known Budd-Chiari syndrome palliated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure. He had 2 revisions following hepatic vein angioplasty. The images provided are procedural and contrast-enhanced CT scans following the TIPS procedure. Note the inhomogeneous enhancement, mimicking metastases.

(Enlarge Image)

Media file 47: A 26-year-old man with known Budd-Chiari syndrome palliated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure. He had 2 revisions following hepatic vein angioplasty. The images provided are procedural and contrast-enhanced CT scans following the TIPS procedure. Note the inhomogeneous enhancement, mimicking metastases.

[ CLOSE WINDOW ]

A 26-year-old man with known Budd-Chiari syndrome palliated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure. He had 2 revisions following hepatic vein angioplasty. The images provided are procedural and contrast-enhanced CT scans following the TIPS procedure. Note the inhomogeneous enhancement, mimicking metastases.

(Enlarge Image)

Media file 48: A 26-year-old man with known Budd-Chiari syndrome palliated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure. He had 2 revisions following hepatic vein angioplasty. The images provided are procedural and contrast-enhanced CT scans following the TIPS procedure. Note the inhomogeneous enhancement, mimicking metastases.

[ CLOSE WINDOW ]

A 26-year-old man with known Budd-Chiari syndrome palliated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure. He had 2 revisions following hepatic vein angioplasty. The images provided are procedural and contrast-enhanced CT scans following the TIPS procedure. Note the inhomogeneous enhancement, mimicking metastases.

(Enlarge Image)

Media file 49: A 26-year-old man with known Budd-Chiari syndrome palliated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure. He had 2 revisions following hepatic vein angioplasty. The images provided are procedural and contrast-enhanced CT scans following the TIPS procedure. Note the inhomogeneous enhancement, mimicking metastases.

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A 26-year-old man with known Budd-Chiari syndrome palliated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure. He had 2 revisions following hepatic vein angioplasty. The images provided are procedural and contrast-enhanced CT scans following the TIPS procedure. Note the inhomogeneous enhancement, mimicking metastases.

(Enlarge Image)

Media file 50: A 26-year-old man with known Budd-Chiari syndrome palliated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure. He had 2 revisions following hepatic vein angioplasty. The images provided are procedural and contrast-enhanced CT scans following the TIPS procedure. Note the inhomogeneous enhancement, mimicking metastases.

[ CLOSE WINDOW ]

A 26-year-old man with known Budd-Chiari syndrome palliated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure. He had 2 revisions following hepatic vein angioplasty. The images provided are procedural and contrast-enhanced CT scans following the TIPS procedure. Note the inhomogeneous enhancement, mimicking metastases.

(Enlarge Image)

Media file 51: A 26-year-old man with known Budd-Chiari syndrome palliated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure. He had 2 revisions following hepatic vein angioplasty. The images provided are procedural and contrast-enhanced CT scans following the TIPS procedure. Note the inhomogeneous enhancement, mimicking metastases.

[ CLOSE WINDOW ]

A 26-year-old man with known Budd-Chiari syndrome palliated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure. He had 2 revisions following hepatic vein angioplasty. The images provided are procedural and contrast-enhanced CT scans following the TIPS procedure. Note the inhomogeneous enhancement, mimicking metastases.

(Enlarge Image)

Media file 52: A 26-year-old man with known Budd-Chiari syndrome palliated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure. He had 2 revisions following hepatic vein angioplasty. The images provided are procedural and contrast-enhanced CT scans following the TIPS procedure. Note the inhomogeneous enhancement, mimicking metastases.

[ CLOSE WINDOW ]

A 26-year-old man with known Budd-Chiari syndrome palliated with a transjugular intrahepatic portosystemic shunt (TIPS) procedure. He had 2 revisions following hepatic vein angioplasty. The images provided are procedural and contrast-enhanced CT scans following the TIPS procedure. Note the inhomogeneous enhancement, mimicking metastases.

More on Budd-Chiari Syndrome

Overview: Budd-Chiari Syndrome

Imaging: Budd-Chiari Syndrome

Follow-up: Budd-Chiari Syndrome

Multimedia: Budd-Chiari Syndrome

References

Budd G. On Diseases of the Liver. London, England: John Churchill; 1845:146.
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Valla DC. Primary Budd-Chiari syndrome. J Hepatol. Jan 2009;50(1):195-203. [Medline].
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Hoekstra J, Janssen HL. Vascular liver disorders (I): diagnosis, treatment and prognosis of Budd-Chiari syndrome. Neth J Med. Sep 2008;66(8):334-9. [Medline].
Ono J, Sakoda K, Kawada T. Membranous obstruction of the inferior vena cava. Ann Surg. Apr 1983;197(4):454-8. [Medline].
Dahnert W. Radiology Review Manual. 6th Edition. Philadelphia, Pa: Wolters Kluwer Health; 2006.
Murad SD, Valla DC, de Groen PC, Zeitoun G, Hopmans JA, Haagsma EB. Determinants of survival and the effect of portosystemic shunting in patients with Budd-Chiari syndrome. Hepatology. Feb 2004;39(2):500-8. [Medline].
Kandpal H, Sharma R, Gamangatti S, Srivastava DN, Vashisht S. Imaging the inferior vena cava: a road less traveled. Radiographics. May-Jun 2008;28(3):669-89. [Medline].
Brancatelli G, Vilgrain V, Federle MP, Hakime A, Lagalla R, Iannaccone R. Budd-Chiari syndrome: spectrum of imaging findings. AJR Am J Roentgenol. Feb 2007;188(2):W168-76. [Medline].
Torabi M, Hosseinzadeh K, Federle MP. CT of nonneoplastic hepatic vascular and perfusion disorders. Radiographics. Nov-Dec 2008;28(7):1967-82. [Medline].
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Soyer P, Rabenandrasana A, Barge J, Laissy JP, Zeitoun G, Hay JM. MRI of Budd-Chiari syndrome. Abdom Imaging. Jul-Aug 1994;19(4):325-9. [Medline].
Bertolotto M, Martinoli C, Migaleddu V, Cernic S, Zappetti R. Color Doppler sonography of intrahepatic vascular shunts. J Clin Ultrasound. Nov-Dec 2008;36(9):527-38. [Medline].
Hermeziu B, Franchi-Abella S, Plessier A, Habes D, Mosca A, Sibert A, et al. Budd-Chiari syndrome and essential thrombocythemia in a child: favorable outcome after transjugular intrahepatic portosystemic shunt. J Pediatr Gastroenterol Nutr. Mar 2008;46(3):334-7. [Medline].
Murad SD, Luong TK, Pattynama PM, Hansen BE, van Buuren HR, Janssen HL. Long-term outcome of a covered vs. uncovered transjugular intrahepatic portosystemic shunt in Budd-Chiari syndrome. Liver Int. Feb 2008;28(2):249-56. [Medline].
Bogin V, Marcos A, Shaw-Stiffel T. Budd-Chiari syndrome: in evolution. Eur J Gastroenterol Hepatol. Jan 2005;17(1):33-5. [Medline].
Senzolo M, Cholongitas EC, Patch D, Burroughs AK. Update on the classification, assessment of prognosis and therapy of Budd-Chiari syndrome. Nat Clin Pract Gastroenterol Hepatol. Apr 2005;2(4):182-90. [Medline].
Bayraktar Y, Egesel T, Saglam F, et al. Does hepatic vein outflow obstruction contribute to the pathogenesis of hepatocellular carcinoma?. J Clin Gastroenterol. Jul 1998;27(1):67-71. [Medline].
Chawla Y, Kumar S, Dhiman RK, et al. Duplex Doppler sonography in patients with Budd-Chiari syndrome. J Gastroenterol Hepatol. Sep 1999;14(9):904-7. [Medline].
Espinosa G, Font J, Garcia-Pagan JC, et al. Budd-Chiari syndrome secondary to antiphospholipid syndrome: clinical and immunologic characteristics of 43 patients. Medicine (Baltimore). Nov 2001;80(6):345-54. [Medline].
Kim TK, Chung JW, Han JK, et al. Hepatic changes in benign obstruction of the hepatic inferior vena cava: CT findings. AJR Am J Roentgenol. Nov 1999;173(5):1235-42. [Medline].
Kugelmas M. Budd-Chiari syndrome. Treatment options and the value of liver transplantation. Hepatogastroenterology. Sep-Oct 1998;45(23):1381-6. [Medline].
McKusick MA. Imaging findings in Budd-Chiari syndrome. Liver Transpl. Aug 2001;7(8):743-4. [Medline].
Michl P, Bilzer M, Waggershauser T, et al. Successful treatment of chronic Budd-Chiari syndrome with a transjugular intrahepatic portosystemic shunt. J Hepatol. Mar 2000;32(3):516-20. [Medline].
Murphy FB, Steinberg HV, Shires GT 3rd, et al. The Budd-Chiari syndrome: a review. AJR Am J Roentgenol. Jul 1986;147(1):9-15. [Medline].
Nonami T, Yokoyama I, Iwatsuki S, Starzl TE. The incidence of portal vein thrombosis at liver transplantation. Hepatology. Nov 1992;16(5):1195-8. [Medline].
Ong JP, Sands M, Younossi ZM. Transjugular intrahepatic portosystemic shunts (TIPS): a decade later. J Clin Gastroenterol. Jan 2000;30(1):14-28. [Medline].
Seki S, Sakaguchi H, Kobayashi S, et al. Transjugular intrahepatic portosystemic shunt in combination with oral anticoagulant for Budd-Chiari syndrome. Hepatogastroenterology. Sep-Oct 2001;48(41):1447-9. [Medline].
Singh V, Sinha SK, Nain CK, et al. Budd-Chiari syndrome: our experience of 71 patients. J Gastroenterol Hepatol. May 2000;15(5):550-4. [Medline].
Tisnado JC, Carithers RL Jr, Goldschmidt RA. The Budd-Chiari syndrome: angiographic pathologic correlation. Radiographics. 1983;3:155.

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Keywords

Budd-Chiari syndrome, BCS, Chiari syndrome, hepatic outflow obstruction, hepatic venous outflow obstruction, hepatic venous occlusion, fibrosis of intrahepatic veins, thrombosis of hepatic veins

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Contributor Information and Disclosures

Author

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR, Consultant Radiologist, North Manchester General Hospital, The Pennine Acute NHS Trust, Manchester UK
Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR is a member of the following medical societies: American Association for the Advancement of Science, American Institute of Ultrasound in Medicine, British Medical Association, British Society of Interventional Radiology, Royal College of Physicians, Royal College of Physicians and Surgeons of the United States, Royal College of Radiologists, and Royal College of Surgeons of England
Disclosure: Nothing to disclose.

Coauthor(s)

Muthusamy Chandramohan, MBBS, DMRD, FRCR, Consultant Radiologist, Bradford Teaching Hospitals, UK
Disclosure: Nothing to disclose.

Sumaira MacDonald, MBChB, PhD, MRCP, FRCR, Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute
Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Medical Editor

Zahir Amin, MD, MBBS, MRCP, FRCR, Consulting Staff, Department of Imaging, University College Hospital, UK
Zahir Amin, MD, MBBS, MRCP, FRCR is a member of the following medical societies: British Institute of Radiology, British Medical Association, and Royal College of Radiologists
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Udo P Schmiedl, MD, PhD, Clinical Professor, Department of Radiology, University of Washington; Consulting Staff, Swedish Medical Center, University of Washington Medical Center, Seattle Radiologists
Udo P Schmiedl, MD, PhD is a member of the following medical societies: American College of Radiology and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, Resolution Imaging Medical Corporation
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

John Karani, MBBS, FRCR, Clinical Director of Radiology and Consultant Radiologist, Department of Radiology, King's College Hospital, London
John Karani, MBBS, FRCR is a member of the following medical societies: British Institute of Radiology, British Society of Interventional Radiology, Cardiovascular and Interventional Radiological Society of Europe, European Society of Gastrointestinal and Abdominal Radiology, European Society of Radiology, Radiological Society of North America, and Royal College of Radiologists
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Budd-Chiari Syndrome: Multimedia

Multimedia

Inferior venacavogram shows compression and lateral displacement of the inferior vena cava by an enlarged caudate lobe.

Wedged hepatic venogram shows a coarse-mesh spiderweb pattern resulting from an intrahepatic network of collateral vessels.

Inferior venacavogram shows an upper inferior vena cava stenosis with reflux of the contrast into the hepatic venous circulation due to partial obstruction of the distal inferior vena cava.

Following placement of a wall stent in the upper inferior vena cava, a wide patency of the inferior vena cava is seen (same patient as in Image 6). Note the lack of reflux of contrast into the hepatic veins.

Budd-Chiari syndrome: Two ultrasound images (see below) from a 13-year old boy who presented with jaundice, abdominal distention, and features of hepatic encephalopathy and sepsis. Ultrasound showed bilateral pleural effusions, ascites, and no flow within the hepatic veins but a patent IVC.

Budd-Chiari syndrome: Two ultrasound images (see above) from a 13-year old boy that presented with jaundice, abdominal distention, and features of hepatic encephalopathy and sepsis. Ultrasound showed bilateral pleural effusions, ascites, and no flow within the hepatic veins but a patent IVC.

Budd-Chiari syndrome: Six ultrasound images of a 28-year-old female who presented with a nonspecific illness and abnormal liver function tests. The ultrasound scans show no flow in hepatic veins, compressed IVC, enlarged caudate lobe, splenomegaly, and varices at the splenic hilum.

Budd-Chiari syndrome: Six ultrasound images of a 28-year-old female that presented who a nonspecific illness and abnormal liver function tests. The ultrasound scans show no flow in hepatic veins, compressed IVC, enlarged caudate lobe, splenomegaly, and varices at the splenic hilum.

Budd-Chiari syndrome: Six ultrasound images of a 28-year-old female who presented with a nonspecific illness and abnormal liver function tests. The ultrasound scans show no flow in hepatic veins, compressed IVC, enlarged caudate lobe, splenomegaly, and varices at the splenic hilum.

Budd Chiari Syndrome: Six Ultrasound images on a 28-year old female that presented with a non-specific illness and abnormal liver function tests. The Ultrasound scans show no flow in hepatic veins, compressed IVC, enlarged caudate lobe, splenomegaly and varices at the splenic hilum.

Budd-Chiari syndrome: Six ultrasound images of a 28-year-old female who presented with a nonspecific illness and abnormal liver function tests. The ultrasound scans show no flow in hepatic veins, compressed IVC, enlarged caudate lobe, splenomegaly, and varices at the splenic hilum.

Budd-Chiari syndrome: Contrast-enhanced axial CT scan showing a large ascites, patchy enhancement of the liver, an enlarged caudate lobe, attenuated hepatic veins, hepatic vein–portal vein shunts, and a thrombus within the intrahepatic IVC.

Budd-Chiari syndrome: Contrast-enhanced axial CT scan showing a large ascites, patchy enhancement of the liver, an enlarged caudate lobe, attenuated hepatic veins, hepatic vein–portal vein shunts, and a thrombus within the intrahepatic IVC.

Budd-Chiari syndrome: Contrast-enhanced axial CT scan showing a large ascites, patchy enhancement of the liver, an enlarged caudate lobe, attenuated hepatic veins, hepatic vein–portal vein shunts, and a thrombus within the intrahepatic IVC.

Acute Budd-Chiari syndrome with recovery. A 36-year-old female patient with known Behcet's disease presented with abdominal distention, leg edema, and abnormal liver function tests. Nonenhanced in-phase T2WI shows heterogeneity of the liver parenchyma. Note the thrombus in the IVC and the ascites.

Acute Budd-Chiari syndrome with recovery. A 36-year-old female patient with known Behcet's disease presented with abdominal distention, leg edema, and abnormal liver function tests. Nonenhanced in-phase T2WI shows heterogeneity of the liver parenchyma. Note the thrombus in the IVC and the ascites.

Acute Budd-Chiari syndrome with recovery. A 36-year-old female patient with known Behcet's disease presented with abdominal distention, leg edema, and abnormal liver function tests. Nonenhanced in-phase T2WI shows heterogeneity of the liver parenchyma. Note the thrombus in the IVC and the ascites.

Acute Budd-Chiari syndrome with recovery. A 36-year-old female patient with known Behcet's disease presented with abdominal distention, leg edema, and abnormal liver function tests. Nonenhanced in-phase T2WI shows heterogeneity of the liver parenchyma. Note the thrombus in the IVC and the ascites.

Gadolinium-enhanced out-of-phase T2WIs demonstrate the inhomogeneous perfusion of the liver, which is characteristic of the disease. The IVC thrombosis is extending to the right renal vein.

Gadolinium-enhanced out-of-phase T2WIs demonstrate the inhomogeneous perfusion of the liver, which is characteristic of the disease. The IVC thrombosis is extending to the right renal vein.

Gadolinium-enhanced out-of-phase T2WIs demonstrate the inhomogeneous perfusion of the liver, which is characteristic of the disease. The IVC thrombosis is extending to the right renal vein.

Post-gadolinium in-phase T2WI shows the attenuation of the hepatic veins with the typical late peripheral enhancement of the liver.

Post-gadolinium in-phase T1WI showing the hypertrophied caudate lobe compressing the intra-hepatic IVC

Follow-up T2WI scans 10 months later, showing homogeneous liver parenchyma and partial recanalization of the IVC. The caudate lobe is almost back to its normal size, and the compression on the IVC is significantly reduced. The ascites is no longer seen.

Follow-up T2WI scans 10 months later, showing homogeneous liver parenchyma and partial recanalization of the IVC. The caudate lobe is almost back to its normal size, and the compression on the IVC is significantly reduced. The ascites is no longer seen.

Follow-up T2WI scans 10 months later, showing homogeneous liver parenchyma and partial recanalization of the IVC. The caudate lobe is almost back to its normal size, and the compression on the IVC is significantly reduced. The ascites is no longer seen.

Follow-up T2WI scans 10 months later, showing homogeneous liver parenchyma and partial recanalization of the IVC. The caudate lobe is almost back to its normal size, and the compression on the IVC is significantly reduced. The ascites is no longer seen.

Follow-up T2WI scans 10 months later, showing homogeneous liver parenchyma and partial recanalization of the IVC. The caudate lobe is almost back to its normal size, and the compression on the IVC is significantly reduced. The ascites is no longer seen.

Budd-Chiari syndrome. Technetium-99M sulfur colloid scan of the liver shows peripheral areas diminished uptake due to liver atrophy and intense activity in the caudate lobe due to hypertrophy in a patient with BCS.

Conventional wedged hepatic venogram showing absence of the right hepatic vein and a spiderweb pattern of collaterals and recanalized veins.

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