Budd-Chiari Syndrome Diagnosed by Maximal Intensity Projection and Minimum Intensity Projection of CT Images Prior to Liver Transplantation

Abstract

Introduction: Diagnosis of Budd-Chiari syndrome in cirrhotic patients is usually not easy. We reported a patient with Budd-Chiari syndrome that was detected by Maximum Intensity Projection (MIP) and Minimum Intensity projection (MinIP) from CT images. Case presentation: A 55 year-old man with chronic hepatitis B and a past history of alcoholism was diagnosed to be compensated liver cirrhosis. He received left lateral sectionectomy for hepatic epitheloid angiomyolipoma (4.6×3.5×3.3 cm) and also splenectomy on July 25, 2011. Decompensation of liver with intractable ascites and jaundice occurred 4 months later. Liver transplantation was planned for him and relevant examinations were arranged. Budd-Chiari was discovered incidentally. From venous phase of enhanced CT images, reformed images with Maximum Intensity Projection (MIP), one of volume-rendering techniques, demonstrated enhanced right hepatic vein and no opacification of middle hepatic vein (MHV). Reformed images with Minimum Intensity Projection (MinIP), reveals hypoenhancement of the middle hepatic vein as dark branches on the background of enhanced liver parenchyma. The pictures suggested of thrombosis of MHV. He received living donor liver transplantation with right lobe graft of his daughter on Dec. 1, 2011. Thrombosis in his middle hepatic vein with protruding thrombosis in inferior vena cava was noted during transplantation surgery. The postoperative course was uneverful. Microscopically, his liver reveals micronodular cirrhosis with mixed inflammation in portal area. Some liver lobule exhibited congestion and sinusoid dilatation, compatible with venous occlusion clinically. Conclusion: MIP and MinIP of CT images are helpful in the diagnosis of Budd-Chiari syndrome. Invasive procedures, such as angiography, can be avoided.