3048: Budd-Chiari syndrome after liver transplantation: Sonographic diagnosis

Abstract

Objectives: We report a 48-year old man who underwent the orthotopic liver transplantation because of hepatocellular carcinoma with the decompensation cirrhosis.Methods: We performed an emergency bedside ultrasound examination to the patient in the intensive care unit 2 days after operation because of the allograft dysfunction.Results: On ultrasonography, the allograft became sharply enlarged with hypoechoic and inhomogeneous parenchyma pattern, especially in the left lobe of the liver. Low-level echoes were seen in the hepatic inferior vena cava and color Doppler flow imaging showed some patency of the inferior vena cava. And the waveform showed to be completely monophasic with the high peak systolic velocity measured as 89.8 cm/s. Low-level echoes were also seen in the middle and left hepatic veins, and no patency was seen in 2D and color Doppler ultrasound. Flow reversal was shown in the left portal vein and spectral Doppler demonstrated flow below the baseline in the left portal vein, and the waveform showed to be pulsatile. It indicated that arterioportal shunt may be in the left portal vein due to outflow obstruction.Conclusions: Ultrasonography allows qualitative and quantitative evaluation follow-up after liver transplantation to assess the vascular supply of the graft and to detect Budd-Chiari syndrome. Objectives: We report a 48-year old man who underwent the orthotopic liver transplantation because of hepatocellular carcinoma with the decompensation cirrhosis. Methods: We performed an emergency bedside ultrasound examination to the patient in the intensive care unit 2 days after operation because of the allograft dysfunction. Results: On ultrasonography, the allograft became sharply enlarged with hypoechoic and inhomogeneous parenchyma pattern, especially in the left lobe of the liver. Low-level echoes were seen in the hepatic inferior vena cava and color Doppler flow imaging showed some patency of the inferior vena cava. And the waveform showed to be completely monophasic with the high peak systolic velocity measured as 89.8 cm/s. Low-level echoes were also seen in the middle and left hepatic veins, and no patency was seen in 2D and color Doppler ultrasound. Flow reversal was shown in the left portal vein and spectral Doppler demonstrated flow below the baseline in the left portal vein, and the waveform showed to be pulsatile. It indicated that arterioportal shunt may be in the left portal vein due to outflow obstruction. Conclusions: Ultrasonography allows qualitative and quantitative evaluation follow-up after liver transplantation to assess the vascular supply of the graft and to detect Budd-Chiari syndrome.