Ultrasound Characteristics of Budd-Chiari Syndrome: A Multicenter Analysis

Area of Science:

• Hepatology
• Vascular Medicine
• Diagnostic Imaging

Background:

• Budd-Chiari syndrome (BCS) is a rare hepatic venous outflow obstruction leading to liver failure.
• It presents as primary (thrombotic) or secondary (external compression/invasion).
• Lack of cross-regional data hinders standardized diagnostic criteria for BCS.

Purpose of the Study:

• To establish reproducible ultrasound hallmarks for Budd-Chiari syndrome diagnosis.
• To explore geographic variations in BCS presentation.
• To advocate for harmonized ultrasound protocols in BCS diagnosis and classification.

Main Methods:

• Retrospective review of ultrasound examinations from 118 BCS patients (2010-2020) across China, Germany, India, and Italy.
• Utilized standardized B-mode, Doppler, and contrast-enhanced ultrasound.
• Documented venous patency, caudate lobe size, and collateral pathways.

Main Results:

• The cohort (mean age 46) predominantly had chronic BCS (74%).
• Primary thrombotic BCS (81%) was more common than secondary obstruction (6%).
• Ultrasound revealed hepatic vein thrombosis (70%), collaterals (83%), caudate hypertrophy (30%), and portal vein thrombosis (14%). Regional differences noted in IVC thrombosis and hepatic vein confluence obstruction.

Conclusions:

• Multinational ultrasound series identified reproducible BCS hallmarks: hepatic vein thrombosis, extensive collaterals, and caudate lobe enlargement.
• Geographic phenotypes of BCS were highlighted, with distinct patterns in Chinese versus European cohorts.
• Harmonized ultrasound protocols are crucial for earlier diagnosis, consistent classification, and improved outcomes in BCS.