Presentation
Presented with abdominal pain and distention.
Patient Data
Contrast-enhanced abdomino-pelvic CT scan in the portovenous phase shows a lack of enhancement of hepatic veins, filling defects in the IVC and ascites. There is a reduced and heterogeneous enhancement of liver parenchyma with sparing of the caudate lobe. This finding is seen due to separate venous drainage of this liver segment.
Splenomegaly.
Annotated images
Case Discussion
Acute Budd-Chiari syndrome is caused by thrombosis of hepatic veins and/or suprahepatic IVC. Occlusion of hepatic veins and severe ascites are the typical findings in acute Budd-Chiari syndrome. Liver parenchymal congestion leads to decreased and heterogenous liver enhancement, with the typical sparing of the caudate lobe that is drained directly into the IVC. Thrombosis may extend into the IVC, as is seen in this case. The patent IVC may also be compressed by the enlarged caudate lobe.
Splenomegaly and concurrent portal hypertension are common associations.
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