Budd-Chiari Syndrome in a Patient with Hepatitis C

Area of Science:

• Hepatology
• Vascular Medicine
• Interventional Radiology

Background:

• Chronic Budd-Chiari syndrome can present with cirrhosis, mimicking other chronic liver diseases.
• Portal hypertension management can be challenging, necessitating consideration of underlying or coexisting conditions.
• Hepatocellular carcinoma may coexist with other primary liver pathologies.

Purpose of the Study:

• To report a case of Budd-Chiari syndrome initially misdiagnosed as hepatitis C-related cirrhosis.
• To illustrate the successful management of Budd-Chiari syndrome with angioplasty.
• To emphasize the importance of identifying secondary causes of portal hypertension.

Main Methods:

• Transjugular intrahepatic portosystemic shunting (TIPS) attempted in a patient with decompensated cirrhosis.
• Diagnosis of Budd-Chiari syndrome confirmed via venography, revealing hepatic venous webs.
• Angioplasty performed to address hepatic venous webs and relieve portal hypertension.
• Follow-up venography and liver biopsy to assess treatment efficacy and confirm etiology.

Main Results:

• Budd-Chiari syndrome, caused by hepatic venous webs, was identified as the primary disease.
• Angioplasty successfully resolved symptoms of portal hypertension.
• Follow-up venography confirmed sustained patency of hepatic veins 5 months post-procedure.
• Liver biopsy revealed centrilobular fibrosis, supporting venous occlusion as the cause of cirrhosis.

Conclusions:

• Budd-Chiari syndrome should be considered in patients with difficult-to-manage portal hypertension, even with suspected alternative etiologies like hepatitis C.
• Interventional radiology techniques, such as angioplasty, can effectively treat Budd-Chiari syndrome.
• Accurate diagnosis of primary liver pathology is crucial for effective patient management and treatment outcomes.