Spontaneous regression of Budd-Chiari syndrome (hepatic venous occlusion) in a young female
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A rare case of hepatic vein occlusion in a young woman resolved spontaneously, leading to full recovery without invasive procedures. This highlights the potential for natural resolution of severe hepatic vein thrombosis.
Area of Science:
- Medicine
- Hepatology
- Vascular Medicine
Background:
- Hepatic vein occlusion, a serious condition, typically presents with sudden onset of massive ascites and impaired general health.
- Previous cases often report high mortality rates or require aggressive interventions for ascites management.
Observation:
- An 18-year-old female presented with sudden, severe ascites and poor general condition due to hepatic vein occlusion.
- Diagnosis was confirmed via liver biopsy and angiographic imaging of the caval and hepatic veins, and celiac artery.
- No predisposing factors for the condition were identified.
Findings:
- Conservative management with paracentesis and diuretics resulted in significant improvement within two weeks.
- The patient achieved complete resolution of ascites and normalized liver function tests within four weeks.
- Complete recovery was sustained for over 11 years, with diuretics eventually withdrawn.
Implications:
- This case demonstrates that extensive hepatic vein thrombosis can sometimes resolve spontaneously with complete recovery of liver function.
- It challenges the notion that aggressive interventions are always necessary for managing hepatic vein occlusion.
- The findings suggest a potential for favorable outcomes even in severe cases, warranting further investigation into spontaneous resolution mechanisms.
Abstract:
A case of occlusion of the hepatic veins in an 18-year-old girl is presented. The onset was sudden with massive ascites and markedly impaired general condition. The diagnosis was based on liver biopsy and angiograms of the caval and hepatic veins as well as of the celiac artery. No predisposing factors could be found. The patient was treated conservatively with laparocentesis and diuretics. Clear improvement was seen after two weeks, and after four weeks she had no ascites and could be discharged. All liver function tests were then normalized. After three months, all diuretics could be withdrawn, and in the following 11 years she has remained completely recovered. The case illustrates that also widespread thrombi of the hepatic veins may sometimes rapidly dissolve spontaneously, with apparent total reconstitution of hepatic function. This case is unusual since previously reported cases have had high mortality rates and, in surviving cases, operative procedures or large doses of diuretics have been required to control the ascites.