Budd-Chiari syndrome: shunt selection and post-operative assessment

Radiological investigation of patients with the Budd-Chiari syndrome is helpful in making the diagnosis and to determine the most suitable method of surgical decompression of the portal venous system where this is indicated. The radiological findings in four patients with Budd-Chiari syndrome who were treated by meso-atrial shunt operations are described. The key pre-operative investigation is inferior vena cavography with pressure measurements. Postoperatively shunt patency is most reliably assessed by dynamic CT scanning. Doppler ultrasound studies may detect flow within the shunt but patency may be inferred by observing reversal of blood flow within the portal vein.