Radionuclide venography in Budd-Chiari syndrome with intrahepatic vena-caval obstruction

Radionuclide imaging of the inferior vena cava (RIVC) was performed by injecting [99mTc] phytate into a dorsal pedal vein, as an initial diagnostic procedure for eight patients with clinical features of Budd-Chiari syndrome. In five of them, membranous occlusion of the inferior vena cava (IVC) was proved by contrast venography and subsequent surgery. The other three patients, with histologically verified hepatocellular carcinoma, were proved to have tumor-induced narrowing or occlusion of the IVC by contrast venography. The RIVC findings include a sharply truncated inferior vena cava with marked hand-up of activity, extensive collaterals, and delayed visualization of the heart. Our results indicate that RIVC is as accurate and specific as contrast venography, by demonstrating the occlusion of the IVC and collateral circulation from the functional aspect. This simple and noninvasive method could therefore be used as a first-line test in patients with unexplained edema, ascites, superficial abdominal venous collaterals, and even in patients with hepatocellular carcinoma, for the detection of obstruction in the inferior vena cava.