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Computed tomography (CT) revealed previously undescribed venous thrombosis in Budd-Chiari syndrome patients. This included portal circulation, hepatic veins, and inferior vena cava, aiding diagnosis.
Area of Science:
- Radiology
- Vascular Medicine
- Hepatology
Background:
- Budd-Chiari syndrome is a rare condition characterized by hepatic venous outflow obstruction.
- Portal vein thrombosis is a known complication, but its CT imaging characteristics in Budd-Chiari syndrome require further elucidation.
Purpose of the Study:
- To describe novel CT findings in Budd-Chiari syndrome patients.
- To highlight the role of contrast-enhanced CT in identifying venous thrombosis at multiple sites.
Main Methods:
- Retrospective analysis of four Budd-Chiari syndrome patients.
- Detailed review of contrast-enhanced computed tomographic (CT) scans.
Main Results:
- CT demonstrated low-density venous thrombosis in the portal circulation, hepatic veins, and intrahepatic inferior vena cava in three previously undescribed locations.
- Three of four patients had portal vein thrombosis, with one exhibiting extensive involvement of portal, mesenteric, and splenic veins.
- Distinctive hepatic parenchymal contrast enhancement patterns were observed, potentially linked to associated portal thrombosis.
Conclusions:
- The presence of portal venous thrombosis on CT should raise suspicion for Budd-Chiari syndrome.
- CT detection of hepatic vein and inferior vena cava thrombosis confirms the diagnosis and aids in understanding disease extent.
Abstract:
The authors describe four patients with Budd-Chiari syndrome in whom contrast material-enhanced computed tomographic (CT) scans demonstrated low-density venous thrombosis in three sites not, to our knowledge, previously described with this modality. Thrombosis was seen in the portal circulation, the hepatic veins, and the intrahepatic inferior vena cava. It is known that concomitant portal vein thrombosis may be seen in 20% of patients with Budd-Chiari syndrome. Three of the four patients in the current study had this finding, one with extensive thrombosis of portal, mesenteric, and splenic veins and the other two with portal vein branch involvement. In one patient hepatic vein thrombosis was demonstrated with CT, and in three inferior vena cava clot was demonstrated. All four patients had the distinctive hepatic parenchymal contrast enhancement pattern seen in this condition, which the authors think may be at least partially caused by associated portal thrombosis. The presence of portal venous thrombosis should prompt the observer to consider the diagnosis of Budd-Chiari syndrome. Detection of hepatic vein clot confirms the diagnosis and may be seen in this condition in association with inferior vena cava thrombus.