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Primary Budd-Chiari syndrome versus sinusoidal obstruction syndrome: a review
Feifei Lu1,2, Siqi Jia2,3, Huiyuan Lu2,3
1College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China.
Insights
Budd-Chiari syndrome (BCS) and sinusoidal obstruction syndrome (SOS) are distinct liver vascular disorders causing portal hypertension. This review clarifies their differences in risk factors, clinical presentation, diagnosis, and treatment.
Area of Science:
- Hepatology
- Vascular Biology
- Internal Medicine
Background:
- Budd-Chiari syndrome (BCS) and sinusoidal obstruction syndrome (SOS) are significant hepatic vascular disorders.
- Both conditions can lead to portal hypertension and severe complications like acute liver failure.
- Despite overlapping clinical and imaging features, their obstruction locations and underlying pathologies differ.
Purpose of the Study:
- To review current evidence on Budd-Chiari syndrome (BCS) and sinusoidal obstruction syndrome (SOS).
- To summarize the key differences between primary BCS and SOS.
- To differentiate them based on risk factors, clinical manifestations, diagnostic approaches, and therapeutic strategies.
Main Methods:
- Comprehensive literature review of existing evidence on BCS and SOS.
- Comparative analysis of diagnostic criteria and clinical presentations.
- Synthesis of information regarding heterogeneous risk factors and management protocols.
Main Results:
- BCS involves obstruction from hepatic veins to the vena cava-atrial junction, causing post-sinusoidal portal hypertension.
- SOS is characterized by obstruction within hepatic sinusoids and terminal venules, leading to sinusoidal portal hypertension.
- Distinct risk factors, clinical features, diagnostic challenges, and treatment strategies exist for BCS and SOS.
Conclusions:
- Accurate differentiation between BCS and SOS is crucial for effective management.
- Understanding the unique etiological and pathological aspects of each syndrome guides therapeutic decisions.
- Further research may refine diagnostic accuracy and treatment efficacy for these complex liver vascular diseases.
Abstract:
Budd-Chiari syndrome (BCS) and sinusoidal obstruction syndrome (SOS) are two major vascular disorders of the liver, of which both can cause portal hypertension related complications, but their locations of obstruction are different. BCS refers to the obstruction from the hepatic vein to the junction between the inferior vena cava and right atrium, which is the major etiology of post-sinusoidal portal hypertension; by comparison, SOS is characterized as the obstruction at the level of hepatic sinusoids and terminal venulae, which is a cause of sinusoidal portal hypertension. Both of them can cause hepatic congestion with life-threatening complications, especially acute liver failure and chronic portal hypertension, and share some similar features in terms of imaging and clinical presentations, but they have heterogeneous risk factors, management strategy, and prognosis. Herein, this paper reviews the current evidence and then summarizes the difference between primary BCS and SOS in terms of risk factors, clinical features, diagnosis, and treatment.
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