Budd – Chiari Syndrome
A 47-year-old male had come for a Computed Tomography (C.T.) scan after complaining of abdominal pain from the past few months. The patient had no other medical history. A CT volume scan of his whole abdomen and pelvis was performed from the Xiphisternum to the Pubis symphysis before and after I.V. administration.
CT Scan Findings
Cirrhotic nodular liver with severe narrowing of the supra hepatic IVC with calcified wall and proximal to it IVC gross dilation, with obliterated Hepatic veins, extensive collateral in retroperitoneum around both kidneys, perigastric, peripancreatic, pericholecystic, lower paraesophageal, lienorenal and pelvis, along chest wall, intra hepatic, with associated splenomegaly.
Overall, diagnosis revealed supra hepatic IVC focal calcified wall and severe luminal narrowing, resulting in Budd-Chiari syndrome, associated cirrhosis with portal hypertension.
Budd-Chiari syndrome, also known as hepatic venous outflow obstruction, is a condition in which there is partial or complete obstruction of the hepatic veins.
Its clinical presentation can range from acute to chronic and is dependent on the etiology. The classic clinical triad of ascites, hepatomegaly, and abdominal pain may not occur in all cases. Acute presentations result from hepatic venous or inferior vena cava thrombosis. Chronic presentations are associated with fibrosis of intrahepatic veins related to inflammation.
The etiology of this disease is varied, with most cases resulting from thrombosis within the hepatic veins. However, 25% of cases arise from external compression that leads to obstruction.
The syndrome may also cause other conditions, such as;
1. Portal hypertension (increased pressure in the portal vein, which carries blood from the intestines to the liver).
2. Cirrhosis (scarring of the liver)
3. Esophageal varices (twisted veins in the food tube)
4. Varicose veins (swollen blood vessels) in the abdomen and rectum.
5. Ascites (a buildup of fluid in the intra-abdomen)
Following the original reports of Budd and Chiari in 1845 and 1899, respectively, a number of reports have been published on the genesis of hepatic vein occlusion.
The etiological factors include oral contraceptives, pregnancy, underlying malignancy, cytotoxic chemotherapy, herbal tea and herbal medicines, congenital webs in the inferior vena cava and hepatic veins, abdominal trauma, and thrombotic events.
This patient came with a complaint of abdominal pain but the scan results showed severe, critical, and complex insights. The case was reported in 25 minutes by our radiologist Dr. Abhishek S.
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