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Obstruction / Occlusion, Grafts, Education and training, Stents, Diagnostic procedure, CT, Ultrasound-Colour Doppler, Ultrasound, Vascular, Liver, Abdomen
J. D. Zavariz1, S. M. Tochetto2, F. L. Pereira1, T. N. Oliveira1, M. C. Chammas1; 1São Paulo/BR, 2Chicago, IL/US
Budd–Chiari is a condition caused by outflow obstruction of the hepatic veins related to hyper coagulable states,
including: myeloproliferative syndromes,
paroxysma nocturnal hemoglobinuria,
factor V mutation,
protein C and S deficiencies; some abdominal cancers and use of hormonal contraceptives (associated with any of the above factors).
The blockage causes congestion of the synusoids leading to an increase of liver's size.
The reduced blood flow generates atrophy and necrosis of centrilobular hepatocytes,
followed by fibrosis.
In the acute phase abdominal pain/disconfort and mild jaudice can occur.
The ascites is progressive. Edema in the lower limbs and other symptoms of liver failure can be seen.
As in other liver diseases it can lead to hepatic portal hypertension.
The liver impairment can be fatal.
Depending on which stage the illness is diagnosed it can be treated with anticoagulants or thrombolytic; transjugular intrahepatic portosystemic shunt (TIPS) or liver transplant.
The imaging findings are variable and some pitfalls are potential causes of false-negative.
A correct interpretation is crucial for establishing the diagnosis.
The imaging also plays an important role in interventional procedure (TIPS) and follow up after treatment.