Budd-Chiari syndrome: our experience of 71 patients

Budd-Chiari syndrome and hepatocellular carcinoma: a case report and review of the literature

Acid suppression medications have become A 62-yr-old woman with a long-standing history of presumed cryptogenic cirrhosis was referred for evaluation of an elevated bilirubin level. Workup showed an elevated alpha-fetoprotein level, and a mass in the liver was detected by imaging studies; this was confirmed as hepatocellular carcinoma by biopsy. Her past medical history was significant for a portocaval shunt procedure 30 yr prior; a wedge biopsy obtained at that time had been interpreted as postnecrotic cirrhosis, but upon current review, lesions of acute and chronic venous outflow obstruction consistent with Budd-Chiari syndrome were noted. This case is unusual in two aspects: the patient survived 30 yr after shunt surgery with undiagnosed Budd-Chiari syndrome; and the association of Budd-Chiari syndrome with subsequent hepatocellular carcinoma is uncommon.

Management of Budd-Chiari syndrome by hepatic vein stenting after extended right hepatectomy

Massive splenomegaly and ascites production with hypoproteinemia and hypocoagulability was observed in a 15-year-old boy after extended right hepatectomy for hepatocellular carcinoma (HCC). Angiography disclosed a kinking of the left hepatic vein immediately before the junction with the inferior vena cava. Ascites disappeared completely, and laboratory values normalized after placement of a 3-cm long balloon expandable stent. The current case shows that Budd-Chiari syndrome caused by hepatic outflow obstruction after major hepatic surgery can be managed effectively by percutaneous stent placement.