Systemic thrombolysis for acute, severe Budd-Chiari syndrome

Area of Science:

• Hepatology
• Vascular Medicine
• Interventional Radiology

Background:

• Budd-Chiari syndrome (BCS) is a rare hepatic venous outflow obstruction with diverse causes and presentations.
• Acute BCS presents significant challenges for diagnosis and evidence-based treatment due to its rarity and heterogeneity.
• Limited treatment options exist for acute BCS, especially with extensive inferior vena cava (IVC) thrombus.

Observation:

• A young woman presented with acute, severe BCS and a substantial IVC thrombus burden.
• The acute onset of symptoms facilitated the prompt initiation of systemic thrombolysis.
• Treatment involved a multidisciplinary team approach with close monitoring for efficacy and complications.

Findings:

• Systemic thrombolysis led to the resolution of hepatic vein occlusion.
• The intervention successfully prevented potentially severe clinical sequelae associated with acute BCS.
• Literature review and discussion of current BCS management strategies are included.

Implications:

• Prompt systemic thrombolysis can be an effective treatment for acute, severe BCS with IVC thrombus.
• Multidisciplinary collaboration is crucial for managing complex cases of BCS.
• This case highlights a viable therapeutic option for a rare and challenging clinical presentation.