A Comparative Study of Ultrasonography and CT Venography in the Diagnosis of Budd-Chiari Syndrome.

Application and evaluation of non-invasive examination for Budd-Chiari syndrome

Exploring the utility of EUS in Budd-Chiari syndrome: a multicenter multiobserver prospective cohort study

To compare the efficacy of spiral computed tomographic (CT) venography with conventional venography in the diagnosis of suspected deep venous thrombosis (DVT). In a prospective study, 52 consecutive patients with clinically suspected unilateral or bilateral DVT were studied with CT venography and conventional venography. In cases in which conventional venographic findings were inconclusive, color-coded duplex sonography and follow-up examinations were performed to make a final diagnosis. CT venography of both extremities covered a 100-cm section from the ankle to the inferior vena cava (IVC). Contrast material diluted with saline was injected in a dorsal vein of each foot. CT and conventional venography (including color-coded duplex sonography and follow-up findings) were correlated for three venous regions for each patient. Correlation was excellent between CT and conventional venographic findings in the detection of DVT. The sensitivity of CT venography was 100% (confidence interval: 0.92, 1.00), specificity was 96% (confidence interval: 0.84, 0.98), positive predictive value was 91%, and negative predictive value was 100%. CT venography more clearly demonstrated thrombus extension of DVT into the pelvic veins and IVC than conventional venography alone. CT venography is a valuable tool in the diagnosis of DVT. Compared with conventional venography, CT requires use of 80% less contrast material.

The purpose of this study was to compare combined CT pulmonary angiography and venography with leg sonography for accuracy and relative efficacy in diagnosis of deep venous thrombosis from the popliteal vein to the common femoral vein. Seventy consecutive patients with clinically suspected pulmonary embolism underwent both combined CT pulmonary angiography and venography and bilateral leg sonography within 24 hr. CT venograms were analyzed independently in a blinded fashion for quality of venous opacification and patency by two observers. CT venography was compared with sonography for femoropopliteal vein thrombosis, and the final assessment based on multiple subjective and objective clinical and imaging criteria was recorded in three categories: 1, CT venography better than sonography; 2, CT venography equivalent to sonography; and 3, sonography better than CT venography. Sixty-eight patients (97%) had a satisfactory or good quality CT venography examination. Two CT venography studies had false-positive findings due to flow artifacts. Both CT venography and sonography had positive findings for deep venous thrombosis in five patients, and both had negative findings in 63 patients (100% sensitivity, 97% specificity, 100% negative predictive value, and 71% positive predictive value). CT venography was better and more efficacious than sonography (category 1) in 25 patients (36%). CT venography was equivalent to sonography (category 2) in 26 patients (37%), and sonography was better than CT venography (category 3) in 19 patients (27%). Compared with sonography, CT venography in addition to CT pulmonary angiography is a relatively accurate method for evaluation of femoropopliteal venous thrombosis. Combined CT pulmonary angiography and CT venography may be more efficacious than sonography or two separate examinations in selected patients.

To investigate the characteristics and diagnostic value of three-dimensional contrast-enhanced magnetic resonance angiography (3D CE-MRA) in the diagnosis of Budd-Chiari syndrome (BCS). One hundred thirty-three BCS patients underwent 3D CE-MRA, 64 patients had primary BCS, and 69 had secondary BCS. Fifty five cases (41.4%) showed a segmental stenosis of the inferior vena cava, 9 cases (6.8%) a membranous obstruction of the inferior vena cava, 5 cases (3.8%) an unobstructed inferior vena cava and hepatic veno-occlusive condition, 16 cases (12.0%) an inferior vena cava stenosis and hepatic veno-occlusive disease, and 48 cases (36.1%) an intraluminal filling defect in the inferior vena cava. In 52 cases (39.1%), collateral blood vessels were formed, with deep, medium, and shallow portal veins and intrahepatic collateral veins in 88 groups. Among these, 41 (46.6%) had deep venous collateral channels, 24 (27.3%) had medium venous collateral channels, 9 (10.2%) had superficial venous collateral channels, 5 (5.7%) had portal vein collateral channels, and 9 (10.2%) had intrahepatic venous collateral channels. 3D CE-MRA is important in the clinical diagnosis and treatment planning of BCS and displays hepatic veins, the inferior vena cava system, and collateral vessels.

Objective To study the application of multiple row spiral CT (MSCT) in the diagnosis of inferior vena cava lesions in Budd Chiari syndrome (BCS) and its clinical value. Methods Eighty patients with BCS admitted to the Central Hospital of Shan County from May 2017 to May 2018 were divided into two groups by digital grouping method, with 40 cases in each group.The control group was diagnosed by ultrasound, and the study group was diagnosed by multi-slice CT.The pathological changes, tissue contrast of inferior vena cava and hepatic vein and the diagnostic sensitivity, specificity, positive predictive value and negative predictive value of inferior vena cava obstruction were compared between the two groups. Results The pathological diagnosis rate in the study group was significantly higher than that in the control group(χ2=4.562, 4.695, 4.125, 5.124, all P<0.05). The contrast of inferior vena cava and hepatic vein tissues in the study group was significantly higher than that in the control group (t=12.897, 13.214, all P<0.05). The sensitivity, specificity, positive predictive value and negative predictive value of the diagnosis of inferior vena cava occlusion in the study group were higher than those in the control group (the control group: 91.2%, 98.6%, 97.3%, 80.3%, the study group: 100.0%, 99.5%, 98.2%, 100.0%, χ2=11.897, 10.214, 11.235, 13.564, all P<0.05). Conclusion The application of MSCT in the diagnosis of BCS-inferior vena cava lesions, can display the lesions comprehensively and intuitive guidance in the treatment of inferior vena cava lesions, has high diagnostic value, it is worthy of popularization and application in clinic. Key words: Tomography, spiral computed; Budd-Chiari syndrome; Vena cava, inferior; Diagnosis; Ultrasonography; Sensitivity and specificity

Objective To investigate the diagnosis and interventional therapeutic technology for the obstruction of hepatic vein(HV)or inferior vena cava(IVC)after liver transplantation.Methods In the 831 patients who received orthotopic liver transplantation(OLT)and 26 patients who received living donorliver transplantation(LDLT),11 cases were confirmed with HV or IVC obstruction by venography and received interventional treatment from 2 to 111 days after liver transplantation.Of the 11 patients,five had the obstruction of HV anastomosis,five had the obstruction of IVC anastomosis,and one had the obstructionof HV and IVC anastomosis.In the eleven patients,five patients underwent OLT,four patients underwent LDLT,and two pediatric patients underwent reduced-size OLT.Before interventional treatment,9 patients received CT enhanced scans,2 received MR enhanced scans.Follow-up evaluations included liver or renalfunction tests,clinical symptom,and monitoring of HV or IVC flow.Pressure gradients before and after interventional treatment were compared by using a paired t test.The imaging data and interventional therapeutic technology of 11 cases were retrospectively analyzed.Results In all 11 patients,CT or MRI could clearly show congested areas of the liver,and the location and degree of HV or IVC obstruction.Of the 11 patients,four with HV obstruction and five with IVC obstruction were treated with stent placement,one with HV obstruction was treated with percutaneous transluminal angioplasty(PTA),one with HV and IVCobstruction was treated with HV PTA and IVC stent placement.Interventional technical success was achievedin all patients.The venous pressure gradient across obstruction was significantly reduced from(16.5±4.1)mm Hg(1 mm Hg=0.133 kPa)before the procedure to(2.9±1.7)mm Hg after the rocedure(t=11.5,P＜0.01).Clinical improvement was noted in 10 patients except one pediatric patient who died of multiple-organs failure at the 9 th day after the treatment During the follow-up period of 9 to 672 days,two patients with PTA treatment had recurrent HV stenosis within one month after treatment,no patient with stent placement developed venous restenosis.No major complications occurred during the procedures.Conclusions Stent placement is safe and effective for HV or IVC obstruction after liver transplantation.CT or MRI before treatment is of important value for the diagnosis of congested areas of the liver,and theobservation of HV or IVC obstruction. Key words: Liver transplantation; Postoperative complications; Hepatic vein-occlusive disease; Radiology,interventional; Inferior vena cava

To prospectively determine the value of blood flow velocity in the inferior vena cava (IVC) on color Doppler ultrasonography for the optimization of the delay in scanning time after contrast injection during computed tomography (CT) venography in patients with Budd-Chiari syndrome (BCS) with IVC obstruction. We enrolled 122 consecutive BCS patients with IVC obstruction. All patients underwent color Doppler ultrasonography, CT venography, and digital subtraction angiography (DSA) in that order prior to treatment. The delay in scanning time during CT venography was set at 120, 180, 240, and 300s after contrast injection. The correlation between delay in CT scanning and IVC blood flow velocity on color Doppler ultrasonography was explored. Image quality was classified as good, moderate, or poor. Patients with good CT image quality were considered to have an optimal delay in scanning time. Delays in scanning time of 120, 180, 240, and 300s yielded good-quality images in 2, 7, 49, and 64 patients, respectively. The corresponding IVC blood flow velocities in these patients were 16.10±0.42cm/s (range 15.8-16.4cm/s), 12.90±1.58cm/s (range, 11-15cm/s), 7.53±1.35cm/s (range 5-10cm/s), and 1.95±1.75cm/s (range 0-5.5cm/s). IVC blood flow velocity on color Doppler ultrasonography could serve as a useful tool for the optimization of the delay in scanning time during CT venography to ensure good-quality images for the diagnosis of BCS with IVC obstruction.

Fulminant hepatic failure from the Budd-Chiari syndrome. A bridge to transplantation with transjugular intrahepatic portosystemic shunt.

Classification of Hepatic Venous Outflow Obstruction: Ambiguous Terminology of the Budd-Chiari Syndrome

Case Reports1 July 1952CASE REPORT OF STENOSIS OF THE VENA CAVA WITH VENA CAVAL AND HEPATIC VEIN THROMBOSIS RELATED TO TRAUMARAYMOND D. LITTLE, M.D., P. O'B. MONTGOMERY, M.D.RAYMOND D. LITTLE, M.D.Search for more papers by this author, P. O'B. MONTGOMERY, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-37-1-197 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptApproximately 115 cases of the Budd-Chiari syndrome have been reported to date. The most common causes of hepatic vein thrombosis are intraabdominal malignant disease, inflammatory disease and blood dyscrasias.1-14Trauma is thought by some to be a rare cause. Stenosis of the inferior vena cava is not a common associated finding. In 1906, Sternberg reported a case of stenosis of the inferior vena cava at the level of its hepatic portion with thrombosis of the hepatic vein.8Nishihowa in 1918 reported three cases with stenosis of the cava as it passed through the diaphragm, and two cases of stenosis below...Bibliography1. AltschuleWhite MG: Chiari's syndrome in patient with polycythemia vera; report of case, New England J. Med. 220: 1030, 1939. CrossrefGoogle Scholar2. ArmstrongCarnes CDWH: Observation of hepatic veins (Chiari's disease); report of 5 cases, Am. J. M. Sc. 208: 470, 1944. CrossrefGoogle Scholar3. BaehrKlemperer GP: Thrombosis of portal and of hepatic veins, M. Clin. North America 14: 391, 1930. Google Scholar4. Carcinoma of pylorus, infiltrating duodenum and mesentery, Cabot case 29191, New England J. Med. 228: 620, 1943. Google Scholar5. Cholangitis, with abscess formation and thrombosis of hepatic veins, Cabot case 27431, New England J. Med. 225: 661, 1941. CrossrefGoogle Scholar6. Cole NB: Comments on case of polycythemia rubra vera with autopsy, M. Clin. North America 16: 1255, 1933. Google Scholar7. HallockWatsonBerman PCJL: Primary tumor of inferior vena cava, with clinical features suggestive of Chiari's disease, Arch. Int. Med. 66: 50, 1940. CrossrefGoogle Scholar8. Hoover CF: Obstruction of hepatic veins, J. A. M. A. 74: 1753, 1920. CrossrefGoogle Scholar9. JacobsonGoodpasture VCEW: Occlusion of the entire inferior vena cava by hypernephroma, with thrombosis of the hepatic vein and its branches, Arch. Int. Med. 22: 86, 1918. CrossrefGoogle Scholar10. KahnSpring SM: Thrombosis of the hepatic veins—Chiari's syndrome; report of a case with biopsy and venous pressure determination, Ann. Int. Med. 14: 1075, 1940. LinkGoogle Scholar11. SimondsCallaway JPJW: Anatomical changes in livers of dogs following mechanical constriction of hepatic veins, Am. J. Path. 8: 159, 1932. MedlineGoogle Scholar12. Sohval AR: Hepatic complications in polycythaemia vera, with particular reference to thrombosis of hepatic and portal veins and hepatic cirrhosis, Arch. Int. Med. 62: 925, 1938. CrossrefGoogle Scholar13. KelseyComfort MPMW: Occlusion of hepatic veins; review of 20 cases, Arch. Int. Med. 75: 175, 1945. CrossrefGoogle Scholar14. Thompson RB: Thrombosis of the hepatic veins; the Budd-Chiari syndrome, Arch. Int. Med. 80: 602, 1947. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: *Received for publication December 18, 1950.From the Veterans Administration Hospital, McKinney, Texas, and Southwestern Medical School of the University of Texas, Dallas, Texas.Reviewed in the Veterans Administration and published with the approval of the Chief Medical Director. The statements and conclusions published by the authors are the result of their own study and do not necessarily reflect the opinion or policy of the Veterans Administration. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byPost traumatic inferior vena cava thrombosis: A case report and review of literatureThrombose post-traumatique de la veine cave inférieure.Inferior Vena Cava Syndrome Resulting from a Posttraumatic Intrahepatic BilomaBudd-Chiari syndrome resulting from intrahepatic IVC compression secondary to blunt hepatic traumaBudd-Chiari syndromePosttraumatic Budd-Chiari Syndrome Treated with Thrombolytic Therapy and AngioplastyBlunt traumatic rupture of the right hemidiaphragm and Budd-Chiari syndromePosttraumatic hepatic vein thrombosis (Budd-Chiari syndrome) in a childBudd-Chiari Syndrome Associated with Protein-Losing EnteropathyThrombosis of the Inferior Vena Cava and Hepatic Veins (Budd-Chiari Syndrome)MILTON R. HALES, M.D., JAMES H. SCATLIFF, M.D.ACUTE BUDD-CHIARI SYNDROME SECONDARY TO INTRAHEPATIC HEMATOMA FOLLOWING BLUNT ABDOMINAL TRAUMA: TREATMENT BY OPEN INTRACARDIAC SURGERYChiari's disease and the Budd-Chiari syndromeBudd-Chiari's Syndrome Diagnosed by Means of Phlebography in a Case of a Retroperitoneal SarcomaCHIARI'S DISEASEBUDD-CHIARI SYNDROME (OCCLUSION OF THE HEPATIC VEINS): SEVEN CASES*EDDY D. PALMER 1 July 1952Volume 37, Issue 1Page: 197-203KeywordsBloodInferior vena cavaStenosisThrombosisVeins Issue Published: 1 July 1952 PDF downloadLoading ...

Budd-Chiari syndrome (BCS) is a rare hepatic vascular disorder defined by the presence of partial or complete impairment of hepatic venous drainage in the absence of right heart failure or constrictive pericarditis. Several conditions can lead to BCS, from hypercoagulable states to malignancies. Primary BCS is the most common subtype, and usually bartends hypercoagulability states, while secondary BCS involves tumor invasion or extrinsic compression. A combination of clinical and imaging features leads to the diagnosis of BCS, including (1) direct signs: occlusion or compression of the hepatic veins and/or inferior vena cava, and the presence of venous collaterals; (2) indirect signs: morphological hepatic changes with caudate lobe enlargement; inhomogeneous enhancement, and hypervascular nodules. From a clinicopathological point of view, two forms of BCS can be distinguished: acute and subacute/chronic BCS, although asymptomatic and fulminant forms are also possible. Acute presentations are rare, and symptoms include hepatomegaly, ascites, and hepatic insufficiency. Subacute/chronic forms are the most common presentation, with dysmorphic liver and variable degrees of fibrosis deposition. Patients with chronic BCS can develop benign regenerative nodules (large regenerative nodules or FNH [Focal Nodular Hyperplasia]-like lesions), but are also at a higher risk of hepatocellular carcinoma (HCC). The radiologist role is therefore fundamental in both diagnosis and surveillance of BCS. The aim of this review is to present all clinical and imaging signs that can help to reach the diagnosis of BCS, with their clinical significance, providing tips and tricks for the cross-sectional diagnosis of this condition.

Objective: To summarize the clinical features and prognosis of Budd-Chiari syndrome with hepatopulmonary syndrome (HPS) in children. Methods: The clinical data of a child who had Budd-Chiari syndrome with HPS treated at the Department of Pediatrics of the First Affiliated Hospital of Zhengzhou University in December 2016 was analyzed retrospectively. Taking "Budd-Chiari syndrome" and "hepatopulmonary syndrome" in Chinese or English as the keywords, literature was searched at CNKI, Wanfang, China Biomedical Literature Database and PubMed up to July 2023. Combined with this case, the clinical characteristics, diagnosis, treatment and prognosis of Budd-Chiari syndrome with HPS in children under the age of 18 were summarized. Results: A 13-year-old boy, presented with cyanosis and chest tightness after activities for 6 months, and yellow staining of the skin for 1 week. Physical examination at admission not only found mild yellow staining of the skin and sclera, but also found cyanosis of the lips, periocular skin, and extremities. Laboratory examination showed abnormal liver function with total bilirubin 53 μmol/L, direct bilirubin 14 μmol/L, and indirect bilirubin 39 μmol/L, and abnormal blood gas analysis with the partial pressure of oxygen of 54 mmHg (1 mmHg=0.133 kPa), the partial pressure of carbon dioxide of 31 mmHg, and the alveolar-arterial oxygen gradient of 57 mmHg. Hepatic vein-type Budd-Chiari syndrome, cirrhosis, and portal hypertension were indicated by abdominal CT venography. Contrast-enhanced transthoracic echocardiography (CE-TTE) was positive. After symptomatic and supportive treatment, this patient was discharged and received oxygen therapy outside the hospital. At follow-up until March 2023, there was no significant improvement in hypoxemia, accompanied by limited daily activities. Based on the literature, there were 3 reports in English while none in Chinese, 3 cases were reported. Among a total of 4 children, the chief complaints were dyspnea, cyanosis, or hypoxemia in 3 cases, and unknown in 1 case. There were 2 cases diagnosed with Budd-Chiari syndrome with HPS at the same time due to respiratory symptoms, and 2 cases developed HPS 1.5 years and 8.0 years after the diagnosis of Budd-Chiari syndrome respectively. CE-TTE was positive in 2 cases and pulmonary perfusion imaging was positive in 2 cases. Liver transplantation was performed in 2 cases and their respiratory function recovered well; 1 case received oxygen therapy, with no improvement in hypoxemia; 1 case was waiting for liver transplantation. Conclusions: The onset of Budd-Chiari syndrome with HPS is insidious. The most common clinical manifestations are dyspnea and cyanosis. It can reduce misdiagnosis to confirm intrapulmonary vascular dilatations with CE-TTE at an early stage. Liver transplantation is helpful in improving the prognosis.

Non-contrast-enhanced MR angiography in the diagnosis of Budd-Chiari syndrome (BCS) compared with digital subtraction angiography (DSA): Preliminary results

Objective To explore the value of the application of vascular enhancement technology (VET) in the diagnosis of Budd-Chiari syndrome (BCS) and the evaluation of the therapeutic efficacy of interventional therapy.Methods B-mode ultrasound,color Doppler and VET were performed on 93 patients with BCS for the systematic detection of intrahepatic vessels and the inferior vena cava (IVC),with the static and dynamic images of these vessels stored prior to interventional therapy.Subsequent to the operation,the same procedures were repeated on the vessels concerned and the images were recorded.The definitions of B-mode and VET images of the detected vessels were compared by two sonography experts.Regarding DSA as standard,the diagnostic accordance rate of VET and B-mode imaging of the diseased vessels was compared.Results Of the 613 vessels detected prior to intervention therapy,440 vessels images were distinct by B-mode and 533 by VET(P<0.05).VET demonstrated 37 intrahepatic collaterals which were invisible by B-mode.Regarding DSA as the gold standard,the diagnostic accordance rate of affected vessels of B-mode and VET was 69.2% and 92.5%,respectively(P<0.05).In total 103 therapeutic vessels,B-mode sonography and VET revealed 81 and 95 distinct vessels,respectively(P<0.05).Conclusions VET can improve the definition of veins and venous stents.The combination of VET and color Doppler can improve the clinical value of ultrasound in the diagnosis of BCS and evaluation of the therapeutic efficacy of interventional therapy. Key words: Ultrasonography; Hepatic vein thrombosis; Vascular enhancement technology