[Tomodensitometric semiology of Budd-Chiari syndromes]

Specific computed tomography findings in Budd-Chiari's syndromes are described, based on an analysis of images from five cases. Recognition of these signs assists diagnosis when little evidence of the disease exists or when atypical images are produced. The performance of an angioscan and the study of the changes on repeated imaging provides essential data for liver exploration: on the one hand these emphasize or even unmask the lesions (peripheral multi-lacunar images in the obstructed territory), and on the other hand they assess possible lesions of the inferior vena cava as well as lack of filling of the hepatic veins. Furthermore, they assist avoidance of the trap of pseudo-metastatic images by the particular kinetic of the attenuation of contrasts and the systematization of the lesions. The typical appearance of the liver in Budd-Chiari's syndromes probably results from the conjunction of histopathologic and hemodynamic modifications, notably localized inversions of portal flow and particular by-pass pathways. Computed tomography can be included in exploratory procedures as a non-invasive method capable of confirming the diagnosis of Budd-Chiari's syndrome and of orientating vascular explorations essential for pre-operative evaluation.