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Budd-Chiari syndrome secondary to carcinoma: report of two cases
D Chatel1, R Nottin, G Zeitoun
1Service de Chirurgie Cardiovasculaire, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, Paris, France.
Insights
Diagnosing Budd-Chiari syndrome secondary to carcinoma is challenging, often occurring during emergency surgery. Early histologic diagnosis is crucial for potentially curative treatment, though complete resection is difficult.
Area of Science:
- Hepatology and Surgical Oncology
- Vascular Surgery
Background:
- Budd-Chiari syndrome can be secondary to malignancy.
- Malignancy-related Budd-Chiari syndrome presents diagnostic and therapeutic challenges.
Observation:
- Diagnosis in two patients with Budd-Chiari syndrome secondary to carcinoma was made intraoperatively during emergency right atrial clearance.
- Severe cardiovascular distress complicated the presentation.
Findings:
- Curative resection was not possible in these cases.
- Retro- and suprahepatic vena cava involvement is linked to a poor prognosis.
- Establishing a direct link between carcinoma and Budd-Chiari syndrome origin is difficult.
Implications:
- Early and simple histologic diagnosis is suggested before radical surgical treatment.
- Complete tumor resection offers the only potentially curative option.
- Improved diagnostic strategies are needed for malignancy-associated Budd-Chiari syndrome.
Abstract:
In two patients who had Budd-Chiari syndrome secondary to carcinoma, the diagnosis was made intraoperatively at the time of emergency right atrial clearance required for severe cardiovascular distress. Curative resection was not possible and both patients died. As previously noted in the literature, it is extremely difficult to relate carcinoma to the origin of Budd-Chiari syndrome. Retro- and suprahepatic involvement of the vena cava is associated with a very poor prognosis. Complete resection of these tumors is the only potentially curative treatment. We suggest ways to obtain a simple and early histologic diagnosis before initiating appropriate and radical surgical treatment.