Learning objectives
Ilustrate the Doppler findings in:
- acute Budd-Chiari for diagnostic purpose;
- chronic and non-treated Budd-Chiari,
including pitfalls;
- treated Budd-Chiari and how to evaluate it's success.
Background
Budd–Chiari is a condition caused by outflow obstruction of the hepatic veins related to hyper coagulablestates,
including: myeloproliferative syndromes,
pocitemia vera,
pregnancy,
post-partum,
paroxysma nocturnal hemoglobinuria,
Behcet's disease,
factor V mutation,
antithrombin III,
protein C and S deficiencies; some abdominal cancers anduse of hormonal contraceptives (associated with any of the above factors).
The blockage causescongestion of the synusoids leading to an increase of liver's size.
The reduced blood flow generatesatrophy and necrosis of centrilobular hepatocytes,
followed by fibrosis.
In the acute phase abdominal pain/disconfort and...
Findings and procedure details
The sonographic evaluation of the liver starts with the analysis on B-mode of it's margins,
size,
echotexture and the study of the hepatic veins and retro-hepatic inferior vena cava (IVC).
In the acute form of Budd-Chiari ultrasound shows hepatomegaly and ascites.
If non diagnosed and succesfully treated,
with time the liver developssigns of chronic hepatopaty such as blunt edges,
jagged outline and heterogeneous echotexture (fig.1) with signs of portal hypertension (increased diameter of portal,
splenic and superior mesenteric veins,
ascites and splenomegaly).
As the segment...
Conclusion
Budd–Chiari has a deadly potential but can be reversible if diagnosed on time.
B modeand Doppler ultrasound play an important role in diagnosis and follow up after intervention.It demonstrates not only the late morphological changes in the liver but also allows to observe thrombus and absense of flow within the hepatic veins.
When,
in a more late phase,
venous collaterals develops and shunts with the portal and systemic veins are formed the typical "comma" shape must be recognised.
The knowledge of the pattern of the...
References
Rumack CM et al.
Diagnostic Ultrasound.
4th ed (portuguese).
2012: Ed Elsevier.
Marcelino ASZ et al.
"Chapter 3 - Liver",in,Abdominal ultrasound.
2th edition (portuguese).
2009: Ed.
Revinter.
Chavhan GB et al.
Normal Doppler spectral waveforms of major pediatric vessels: specific patterns.
Radiographics,
2008;28:691-706.
McNaughton DA et al.
Doppler US of the liver made simple.
Radiographics,
2011;31:161-188.
Cura M et al.
Diagnostic and interventionas radiology for Budd-Chiari syndrome.
Radiographics,
2009; 29:669-681.
Ludwig J et al.
Classification of hepatic venous outflow obstruction: ambiguous terminology of the Budd-Chiari...