Budd-Chiari Syndrome Caused by TIPS Malposition: A Case Report.

Area of Science:

• Hepatology
• Vascular Surgery
• Radiology

Background:

• Budd-Chiari syndrome involves hepatic venous outflow obstruction, often due to thrombotic disease.
• Clinical signs include hepatomegaly, ascites, and abdominal pain; imaging shows IVC/hepatic vein occlusion and liver changes.
• Transjugular intrahepatic portosystemic shunt (TIPS) is a treatment, but Budd-Chiari syndrome is an uncommon complication.

Purpose of the Study:

• To report a rare case of Budd-Chiari syndrome occurring after TIPS placement in a liver transplant recipient.
• To illustrate the diagnostic findings of this complication on contrast-enhanced CT.

Main Methods:

• Case report of a liver transplant patient who developed Budd-Chiari syndrome post-TIPS.
• Diagnosis confirmed via contrast-enhanced computed tomography (CT) demonstrating TIPS malposition and hepatic vein ostial occlusion.

Main Results:

• The patient presented with symptoms consistent with Budd-Chiari syndrome post-TIPS.
• Contrast-enhanced CT revealed the proximal TIPS portion was malpositioned in the inferior vena cava (IVC), occluding the hepatic vein ostia.
• This occlusion led to Budd-Chiari syndrome in the transplanted liver.

Conclusions:

• Malposition of the TIPS device can lead to Budd-Chiari syndrome, even in transplanted livers.
• Contrast-enhanced CT is crucial for diagnosing TIPS-related Budd-Chiari syndrome by visualizing device position and venous outflow obstruction.
• This case underscores the importance of precise TIPS placement to avoid iatrogenic hepatic venous outflow complications.