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Hepatic Venous Occlusion Type of Budd-Chiari Syndrome versus Pyrrolizidine Alkaloid-Induced Hepatic Sinusoidal

Yaru Tong1, Ming Zhang1, Zexue Qi2

  • 1Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.

Journal of Personalized Medicine
|April 28, 2023
PubMed

Insights

Budd-Chiari syndrome (BCS-HV) and pyrrolizidine alkaloid-induced hepatic sinusoidal obstructive syndrome (PA-HSOS) often present with similar symptoms. Key imaging differences include hepatic vein collateral circulation and caudate lobe enlargement in BCS-HV, which are absent in PA-HSOS.

Area of Science:

  • Hepatology
  • Radiology
  • Internal Medicine

Background:

  • Hepatic venous occlusion type of Budd-Chiari syndrome (BCS-HV) and pyrrolizidine alkaloid-induced hepatic sinusoidal obstructive syndrome (PA-HSOS) exhibit overlapping clinical and imaging features, increasing the risk of misdiagnosis.
  • Accurate differentiation between BCS-HV and PA-HSOS is crucial for appropriate patient management and treatment strategies.

Purpose of the Study:

  • To identify distinct clinical, laboratory, and imaging indicators for differentiating BCS-HV from PA-HSOS.
  • To evaluate the diagnostic value of various imaging modalities, including Doppler ultrasonography (DUS), CT, and MRI, in distinguishing these two conditions.

Main Methods:

  • Retrospective analysis of 139 patients with BCS-HV and 257 patients with PA-HSOS across six university-affiliated hospitals.
  • Comparison of clinical manifestations, laboratory test results, and imaging features between the two patient groups.
  • Detailed assessment of specific imaging findings such as hepatic vein occlusion, collateral circulation, caudate lobe enlargement, and early liver enhancement nodules.

Main Results:

  • BCS-HV patients were younger on average than PA-HSOS patients (p < 0.05).
  • Hepatic vein collateral circulation (73.90%), enlarged caudate lobe (47.70%), and early liver enhancement nodules (8.46%) were significantly more prevalent in BCS-HV compared to PA-HSOS (p < 0.05).
  • Doppler ultrasonography (DUS) demonstrated higher sensitivity (86.29%) for detecting hepatic vein occlusion and collateral circulation in BCS-HV than CT or MRI (4.55%) (p < 0.001).

Conclusions:

  • Hepatic vein stenosis and collateral circulation are key differentiating imaging features for BCS-HV, especially when PA-containing plant exposure is confirmed.
  • Enhanced CT and MRI may overlook crucial imaging findings, potentially leading to misdiagnosis of BCS-HV as PA-HSOS.
  • DUS is a valuable tool for identifying hepatic vein abnormalities in BCS-HV, aiding in accurate differential diagnosis.

Keywords:
Budd–Chiari syndromeDoppler ultrasonographyhepatic sinusoidal obstructive syndrome

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