7. USG abdomen was suggestive of :
Findings:
1.Right lobe of liver span measures 15 cm.
2. echotexture of liver was heterogenous.
2.Caudate lobe enlargement seen measuring 3.4 x 4.0 cm in size causing
compression of hepatic segment of inferior vena cava measuring
approximately 1 mm in diameter.
3. Right , middle and left hepatic veins could not be appreciated.
4.Dilated and tortuous veins in the epigastric region in anterior abdominal
wall suggestive of collaterals.
5. Moderate free fluid was present in abdomen and pelvis suggestive of
ascites.
Impression :
Veno-occlusive disease with ascites.
8. CECT abdomen study was advised for further evaluation of
Budd – chiari syndrome.
48. USG.
Investigation of choice for initial evaluation of Budd-Chiari
syndrome.
Demonstrate- Morphology of hepatic veins.
-Thrombosis/ occlusion of hepatic veins or IVC.
-Adjacent organs can be assessed.
49. It has separate vein which has not affected by thrombotic
process and drain directly in inferior vena cava.
Caudate lobe drainage thus serve as outflow for intrahepatic
venous collateral.
50. In normal healthy individual doppler wave form is triphasic.
In Budd-chiari syndrome loss of triphasic waveform is seen.
51. IVC graphy with retrograde hepatic vein cannulation.
Percutaneous hepatography(injection of contrast in hepatic
parenchyma under fluoroscopy with serial filming to visualize
hepatic veins entering the IVC)
52. IVC can be obstructed in –Intrahepatic portion.
- Subhepatic portion.
-both intrahepatic and Subhepatic
portion.
53. Causes of IVC obstruction.
• Membrane.
• Tumour thrombus.
• Caudate lobe hypertrophy.
Intrahepatic IVC obstruction is most commonly due to
compression from enlarged caudate lobe.
54.
55.
56.
57. Normal flow pattern of IVC is triphasic.
Flow abnormality seen in Budd-Chiari syndrome is-absent
flow.
-
Uniphasic flow.
HPE-sinusoidal dilatation and congestion(venous out flow obstruction )
bridging necrosis and mild portal fibrosis
FIGURE 77.4 Hepatic venogram in Budd-Chiari syndrome patient 2 in our series. A, Filling defects (thrombi) in the right hepatic vein occupy much of the lumen. B, Typical spiderweb pattern of small venous collaterals shown by injection of dye with the catheter in the wedged position.
IVC occlusion due to fibrotic stenosis/membrane
Tumor thrombus from RCC causing BCS
Fig. 1. Budd–Chiari syndrome; 3D-DCE MRA shows obstruction of the hepatic segment of the inferior vena cava, ‘‘cone’’ tip (arrowhead), and collateral blood vessels of thoracic vertebra (arrow).
