Budd-Chiari syndrome in sarcoidosis

A 34-year-old previously healthy woman presented with bilateral interstitial lung changes and thrombotic occlusions of the hepatic veins. A transcaval wedge resection of the liver and a hepato-caval anastomosis were performed. This operation reestablished the impaired intrahepatic venous flow and relieved the portal hypertension and the associated symptoms. Histopathological examination of both liver and lung tissues revealed noncaseating granulomas without microorganisms, confirming the suspected diagnosis of sarcoidosis. The hepatic veins were demonstrated to be narrowed by sarcoid granulomas forming the mechanical basis for venous stasis and extensive thrombotic occlusions. To our knowledge only one other case of a Budd-Chiari syndrome occurring in a patient with sarcoidosis has been reported.