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Saad Eddin A, Ramzan U, Saad Aldin E. Budd-Chiari syndrome treated with direct intrahepatic portocaval shunt: A case report. Radiol Case Rep 2024; 19:2608-2612. [PMID: 38645960 PMCID: PMC11026531 DOI: 10.1016/j.radcr.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/09/2024] [Accepted: 03/13/2024] [Indexed: 04/23/2024] Open
Abstract
Budd-Chiari syndrome is an uncommon disorder characterized by occlusion of hepatic veins. It can lead to portal hypertension. Most common causes of this syndrome are hypercoagulability states. Transjugular intrahepatic portosystemic shunt is often not possible given the portal venous thrombosis. In these cases, direct intrahepatic portocaval shunt, involving the creation of an access between the portal vein and the systemic circulation via the intrahepatic inferior vena cava has proven to be a feasible alternative, and can improve portal hypertension in these patients. Herein, we present a case of a 37-year-old woman diagnosed with Budd-Chiari syndrome that was successfully treated with percutaneous ultrasound (US)-guided direct intrahepatic portocaval shunt.
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Affiliation(s)
- Assim Saad Eddin
- University of Iowa Hospitals and Clinics, Department of Radiology, 200 Hawkins Dr, Iowa City, IA 52242, USA
| | - Umar Ramzan
- Northwestern University Feinberg School of Medicine, 420 E Superior St, Chicago, IL 60611, USA
| | - Ehab Saad Aldin
- University of Nebraska Medical Center, Department of Radiology, 42nd and Emile St, Omaha, NE 68198, USA
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2
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Xu W, Tang W, Yang W, Sun L, Li W, Wang S, Zang X. Acute liver failure as initial presentation in a Chinese patient with Budd-Chiari syndrome due to protein C deficiency: A case report and literature review. Heliyon 2024; 10:e29776. [PMID: 38707271 PMCID: PMC11068517 DOI: 10.1016/j.heliyon.2024.e29776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024] Open
Abstract
Acute liver failure is an uncommon presentation in the clinic. Common causes for acute liver failure include viral hepatitis and drug-related hepatotoxicity. However, acute liver failure due to Budd-Chiari syndrome is rare. This case highlights the importance of necessary constrast-enhanced imaging studies to rule out vascular etiologies of acute liver failure, in addition to common causes like viral or drug-induced hepatic failure. We present a case of a male Chinese patient who presented with nausea, vomiting, fatigue, and fever after eating a large amount of fatty food. Six days after hospitalization, the patient developed acute liver failure and hepatic encephalopathy. Contrast-enhanced computerized tomography and ultrasound examinations revealed thromboses in the hepatic veins and inferior vena cava. Further testing also showed decreased protein C activity. Therefore, a diagnosis of Budd-Chiari syndrome secondary to protein C deficiency was made. He received supportive care and a transjugular intrahepatic portal shunt. Hepatic function, coagulation panel results, and clinical presentations gradually returned to normal. Budd-Chiari syndrome from protein C deficiency could be a rare but valid cause of acute liver failure in Chinese patients.
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Affiliation(s)
- Wanling Xu
- Department of Emergency Medicine, The First Hospital of Jilin University, Changchun, Jilin, PR China
| | - Wenjing Tang
- Department of Emergency Medicine, The First Hospital of Jilin University, Changchun, Jilin, PR China
| | - Weiying Yang
- Department of Emergency Medicine, The First Hospital of Jilin University, Changchun, Jilin, PR China
| | - Lichao Sun
- Department of Emergency Medicine, The First Hospital of Jilin University, Changchun, Jilin, PR China
| | - Wei Li
- Department of Emergency Medicine, The First Hospital of Jilin University, Changchun, Jilin, PR China
| | - Shouqing Wang
- Department of Ultrasound, The First Hospital of Jilin University, Changchun, Jilin, PR China
| | - Xiuxian Zang
- Department of Emergency Medicine, The First Hospital of Jilin University, Changchun, Jilin, PR China
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3
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Lu F, Jia S, Lu H, Zhao H, Li Z, Zhuge Y, Romeiro FG, Mendez-Sanchez N, Qi X. Primary Budd-Chiari syndrome versus sinusoidal obstruction syndrome: a review. Curr Med Res Opin 2024; 40:303-313. [PMID: 38006404 DOI: 10.1080/03007995.2023.2288909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/24/2023] [Indexed: 11/27/2023]
Abstract
Budd-Chiari syndrome (BCS) and sinusoidal obstruction syndrome (SOS) are two major vascular disorders of the liver, of which both can cause portal hypertension related complications, but their locations of obstruction are different. BCS refers to the obstruction from the hepatic vein to the junction between the inferior vena cava and right atrium, which is the major etiology of post-sinusoidal portal hypertension; by comparison, SOS is characterized as the obstruction at the level of hepatic sinusoids and terminal venulae, which is a cause of sinusoidal portal hypertension. Both of them can cause hepatic congestion with life-threatening complications, especially acute liver failure and chronic portal hypertension, and share some similar features in terms of imaging and clinical presentations, but they have heterogeneous risk factors, management strategy, and prognosis. Herein, this paper reviews the current evidence and then summarizes the difference between primary BCS and SOS in terms of risk factors, clinical features, diagnosis, and treatment.
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Affiliation(s)
- Feifei Lu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
| | - Siqi Jia
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Department of Life Sciences and Biopharmaceutis, Shenyang Pharmaceutical University, Shenyang, China
| | - Huiyuan Lu
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Department of Life Sciences and Biopharmaceutis, Shenyang Pharmaceutical University, Shenyang, China
| | - Haonan Zhao
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Department of Life Sciences and Biopharmaceutis, Shenyang Pharmaceutical University, Shenyang, China
| | - Zhe Li
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Department of Life Sciences and Biopharmaceutis, Shenyang Pharmaceutical University, Shenyang, China
| | - Yuzheng Zhuge
- Department of Gastroenterology, Drum Tower Hospital, Nanjing University School of Medicine, Nanjing, China
| | | | - Nahum Mendez-Sanchez
- Liver Research Unit, Medica Sur Clinic and Foundation, National Autonomous University of Mexico, Mexico City, Mexico
| | - Xingshun Qi
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
- Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, China
- Department of Life Sciences and Biopharmaceutis, Shenyang Pharmaceutical University, Shenyang, China
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Date S, Phatak S, Ambhore AN, Narwane G, Trimukhe D. Budd Chiari Syndrome: A Case Report on Classic Imaging Findings With Successful Intervention. Cureus 2023; 15:e43626. [PMID: 37719537 PMCID: PMC10504857 DOI: 10.7759/cureus.43626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
Budd Chiari syndrome is an unusual vascular disease involving the hepatic vasculature and has significant mortality and morbidity if not treated early. Ultrasonography (USG), Doppler, computed tomography (CT), and magnetic resonance imaging (MRI) have classical imaging findings that can help make a reliable and quick diagnosis. Intervention radiology plays an important role in the treatment of these patients, helping avoid various complications and proper patient management. We are presenting a case report with classical imaging spectrum and highlighting successful intervention with hepatic vein stenting.
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Affiliation(s)
- Saurav Date
- Radiodiagnosis, N. K. P. Salve Institute of Medical Sciences & Research Centre (NKPSIMS) and Lata Mangeshkar Hospital, Nagpur, IND
| | - Suresh Phatak
- Radiodiagnosis, N. K. P. Salve Institute of Medical Sciences & Research Centre (NKPSIMS) and Lata Mangeshkar Hospital, Nagpur, IND
| | - Ashish N Ambhore
- Radiology, N. K. P. Salve Institute of Medical Sciences & Research Centre (NKPSIMS) and Lata Mangeshkar Hospital, Nagpur, IND
| | - Ganesh Narwane
- Radiodiagnosis, N. K. P. Salve Institute of Medical Sciences & Research Centre (NKPSIMS) and Lata Mangeshkar Hospital, Nagpur, IND
| | - Deepali Trimukhe
- Radiodiagnosis, N. K. P. Salve Institute of Medical Sciences & Research Centre (NKPSIMS) and Lata Mangeshkar Hospital, Nagpur, IND
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Shen C, Zhang J, Xia Q. Unexpected Abdominal Wall Varices After Split-Liver Transplantation. Gastroenterology 2023; 165:354-356. [PMID: 36608714 DOI: 10.1053/j.gastro.2022.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/19/2022] [Accepted: 12/23/2022] [Indexed: 01/09/2023]
Affiliation(s)
- Chuan Shen
- Department of Liver Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianjun Zhang
- Department of Liver Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Xia
- Department of Liver Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Zeng Y, Zhang J, Jian W, Zhang Y, Yang Y, Li R, Fu Q. Rhabdoid meningioma with a history of Budd-Chiari syndrome: a case report and review of the literature. Front Oncol 2023; 13:1209244. [PMID: 37503325 PMCID: PMC10370419 DOI: 10.3389/fonc.2023.1209244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023] Open
Abstract
Background Rhabdoid meningioma and Budd-Chiari syndrome are both extremely rare, and there is no report describing the two diseases occurring in the same patient thus far. Herein, we showed an unusual case of rhabdoid meningioma with a history of Budd-Chiari syndrome. Case presentation The man was found to have abnormal liver function during physical examination in 2016 at 36 and was not paid attention to it. In 2019, he went to Beijing YouAn Hospital Affiliated to Capital Medical University for the decompensation of cirrhosis and was diagnosed with Budd-Chiari syndrome, subsequent angiography of the inferior vena cava combined with balloon dilatation were performed, the anticoagulation and hepatoprotective therapy were performed for a long time. When he turned 40 who had magnetic resonance imaging (MRI) that showed a left frontotemporal lobe space-occupying lesion, and postoperative pathological examination confirmed rhabdoid meningioma. He underwent surgery and postoperative adjuvant radiotherapy, but then he developed severe psychiatric symptoms and eventually succumbed to a lung infection two months after treatment. Conclusions Budd-Chiari syndrome and Rhabdoid meningiomas are both extremely rare diseases. To the best of our knowledge, there is no report that the two rare diseases occurred in the same patient, and this is the first case. However, whether there is any link between the two diseases is unclear, more researches are needed to confirm it in the future.
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Affiliation(s)
- Ying Zeng
- Department of Radiation Oncology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jing Zhang
- Department of Radiation Oncology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Wei Jian
- Department of Radiation Oncology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yong Zhang
- Department of Radiation Oncology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ying Yang
- Department of Pathology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Rongqing Li
- Department of Radiation Oncology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qiaofen Fu
- Department of Radiation Oncology, First Affiliated Hospital of Kunming Medical University, Kunming, China
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Kiran HS, Karkra R, Laghima VN, Venkatesh CR. Chronic Extrahepatic Portal Vein Occlusion in a Young Patient. Cureus 2023; 15:e40806. [PMID: 37485108 PMCID: PMC10362884 DOI: 10.7759/cureus.40806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Extrahepatic portal vein obstruction (EHPVO) is a rare condition characterized by the occlusion or narrowing of the portal vein outside the liver. We present a case report of a patient with EHPVO secondary to combined protein C and S deficiency and pancytopenia secondary to hypersplenism, highlighting the clinical presentation, diagnostic challenges, and management strategies. Early recognition of this condition and prompt initiation of appropriate treatment can prevent life-threatening complications such as variceal bleeding and portal hypertension. This case underscores the need for a high index of suspicion for inherited thrombophilias in patients presenting with portal vein thrombosis, particularly in the absence of traditional risk factors.
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Affiliation(s)
- H S Kiran
- Department of General Medicine, JSS Medical College and Hospital, JSS Academy of Higher Education & Research (JSSAHER), Mysuru, IND
| | - Rohan Karkra
- Department of General Medicine, JSS Medical College and Hospital, JSS Academy of Higher Education & Research (JSSAHER), Mysuru, IND
| | - V N Laghima
- Department of General Medicine, JSS Medical College and Hospital, JSS Academy of Higher Education & Research (JSSAHER), Mysuru, IND
| | - C R Venkatesh
- Department of General Medicine, JSS Medical College and Hospital, JSS Academy of Higher Education & Research (JSSAHER), Mysuru, IND
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Role of Inferior Vena Cava (IVC) Recanalization in Patients with Back Pain, Secondary to IVC Obstruction in Budd-Chiari Syndrome. Diagnostics (Basel) 2023; 13:diagnostics13030438. [PMID: 36766542 PMCID: PMC9914368 DOI: 10.3390/diagnostics13030438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To study the prevalence of back pain in patients of Budd-Chiari syndrome (BCS) with inferior vena cava (IVC) obstruction, and to evaluate the role of IVC recanalization in resolution of back pain. METHODS All patients with BCS and IVC obstruction who underwent IVC recanalization between January 2018 and October 2022 were included. Patients with degenerative spine disease or other identifiable causes for back pain were excluded; remaining patients were assessed for the presence of back pain. In patients with back pain, pain relief was assessed at 24 h following IVC recanalization. RESULTS Fifty-eight patients with BCS and IVC occlusion were identified, of which six with degenerative spine diseases were excluded. Of the remaining 52 patients, 34 (65.4%) had back pain, with pain score between 3 and 9. Engorged epidural venous plexus on preprocedural imaging (p = 0.002), and degree of luminal narrowing (p = 0.021) had a significant association with back pain. Twenty-nine of thirty-four patients (85.3%) with back pain had pain relief immediately following IVC recanalization, more so in patients with engorged epidural venous plexus on preprocedural imaging (p < 0.001). CONCLUSION Back pain is one of the under-reported symptoms of IVC obstruction in BCS. IVC recanalization by IVC angioplasty with or without stenting relieves back pain due to the decompression of engorged epidural veins.
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Ezzahi M, Zaid E, Farid A, Allali S, Bouardi NE, Haloua M, Hakima A, Alami B, Boubbou M, Maaroufi M, Lamrani MYA. Budd-Chiari syndrome secondary to retro-hepatic vena cava web: An unusual cause of epigastric pain. Radiol Case Rep 2023; 18:1088-1092. [PMID: 36684614 PMCID: PMC9849858 DOI: 10.1016/j.radcr.2022.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023] Open
Abstract
Epigastric abdominal pain is a common indication for consultation. In the majority of cases, medical history, clinical examination and routine biological exams allow for an easy diagnosis. Sometimes the symptomatology is unusual, in which case it is essential to perform a complete clinical examination and to use various imaging techniques to search for eventual atypical causes. Membranous obstruction of inferior vena cava is a rare cause of such a phenomenon. We describe a Budd-Chiari syndrome caused by membranous obstruction of inferior vena cava in a 66-year-old woman with no medical history as a rare cause of epigastric abdominal pain. We will describe this clinical experience in the light of the literature and point out the contribution of radiological imaging in the diagnosis of this rare pathology.
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Key Words
- ALP, alkaline phosphatase
- ALT, alanine transaminase
- APS, antiphospholipid syndrome
- AST, aspartate aminotransferase
- Anti-LKM, anti-liver and kidney microsome
- Anti-SLA, anti-soluble liver antigen
- BCS, Budd-Chiari syndrome
- Budd-Chiari
- CT
- CT, computed tomography
- GGT, gamma-glutamyl transferase
- HBc, hepatitis B core
- HBs Ag, hepatitis B surface antigen
- HCV, hepatitis C virus
- IVC, inferior vena cava
- MOIVC
- MOIVC, membranous obstruction of inferior vena cava
- MPS, myeloproliferative syndromes
- MRI, magnetic resonance imaging
- PT, prothrombin time
- Supra-hepatic veins
- TIPS, trans-jugular intra-hepatic portosystemic shunt
- Ultrasound
- Vena cava
- WCC, white count cell
- Web
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Affiliation(s)
- Manar Ezzahi
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco,Corresponding author.
| | - Ennasery Zaid
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Aassouani Farid
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Soukayna Allali
- Department of Gastro-Hepato-Enterology - CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Nizar El Bouardi
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Meriem Haloua
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Abid Hakima
- Department of Gastro-Hepato-Enterology - CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Badreeddine Alami
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Meriem Boubbou
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Mustapha Maaroufi
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
| | - Moulay Youssef Alaoui Lamrani
- Department of Radiology and Interventional Imaging, CHU Hassan II Fez, Sidi Mohammed Ben Abdellah University, Centre Hospitalier Hrazem, BP:1835 Atlas, Fès, Avenue Hassan II, Fez 30050, Morocco
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10
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Wiest I, Teufel A, Ebert MP, Potthoff A, Christen M, Penkala N, Dietrich CF. [Budd-Chiari syndrome, review and illustration]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 60:1335-1345. [PMID: 34820810 DOI: 10.1055/a-1645-2760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Budd-Chiari syndrome is a rare vascular disorder characterized by obstruction of the hepatic venous outflow. Various diseases causing coagulopathy play a role in aetiology, such as myeloproliferative disorders. Acute vascular occlusion may lead to acute phlebitis with fever. The classic triad of acute liver failure may be present with ascites, hepatomegaly, and abdominal pain. However, subacute courses of disease were also observed. Because of the variable symptoms and severity extent, depending on the acuity of the course and the extent of the affected vessels, diagnosis is often difficult. Sonography, as a ubiquitously available and cost-effective diagnostic tool, plays a leading role. Doppler ultrasonography can be used to visualize hemodynamics in particular. In acute thrombotic occlusion, the affected hepatic veins usually cannot or only partially be visualized. In non-occluding thrombi, turbulent flow patterns may develop in the area of venous outflow obstruction, and flow velocity is then increased in the area of stenosis. Contrast enhanced ultrasound offers even better specificity of diagnosis. Computed tomography and magnetic resonance imaging can directly visualize thrombi and the cause of obstruction. Once the diagnosis is confirmed, anticoagulation must be initiated, but therapy of the underlying disease must also be started. If symptom-controlling measures are not sufficient, angioplasty/stenting to reopen short-segment stenoses or implantation of a TIPSS device may be considered. Liver transplantation remains ultima ratio. As studies on the precision of diagnostic methods are controversial, the characteristics of imaging for BCS are therefore summarized in this review on the basis of several illustrating case reports.
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Affiliation(s)
- Isabella Wiest
- II. Medizinische Klinik, Sektion Hepatologie, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany
| | - Andreas Teufel
- II. Medizinische Klinik, Sektion Hepatologie, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany.,Klinische Kooperationseinheit Healthy Metabolism, Zentrum für Präventivmedizin und Digitale Gesundheit Baden-Württemberg, Universität Heidelberg, Mannheim, Germany
| | - Matthias Philip Ebert
- Klinische Kooperationseinheit Healthy Metabolism, Zentrum für Präventivmedizin und Digitale Gesundheit Baden-Württemberg, Universität Heidelberg, Mannheim, Germany.,II. Medizinische Klinik, Universitätsklinikum Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim
| | - Andrej Potthoff
- Gastroenterology, Hepatology and Endocrinology, Medizinische Hochschule, Hannover, Germany
| | - Michael Christen
- Allgemeine Innere Medizin (DAIM), Kliniken Beau Site, Salem und Permanence, Bern, Switzerland
| | - Nadine Penkala
- Allgemeine Innere Medizin (DAIM), Kliniken Beau Site, Salem und Permanence, Bern, Switzerland
| | - Christoph F Dietrich
- Allgemeine Innere Medizin (DAIM), Kliniken Beau Site, Salem und Permanence, Bern, Switzerland
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11
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Bonjour TJ. The ambiguous abdomen in a basic military trainee. JAAPA 2021; 34:54-56. [PMID: 34582388 DOI: 10.1097/01.jaa.0000791496.19639.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Timothy J Bonjour
- Timothy J. Bonjour is associate dean of graduate allied health education at the San Antonio Uniformed Services Health Education Consortium and practices emergency medicine at Brooke Army Medical Center, Fort Sam Houston and Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, in San Antonio, Tex. The author has disclosed no potential conflicts of interest, financial or otherwise
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12
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Horiguchi T, Toyama Y, Sakakibara Y, Ikeda A, Kako H, Ina T, Okamura T, Uozu S, Goto Y, Yokoi K, Imaizumi K. Budd-Chiari syndrome caused by latent hepatic metastasis from a thymoma. Respir Med Case Rep 2021; 34:101492. [PMID: 34401316 PMCID: PMC8353463 DOI: 10.1016/j.rmcr.2021.101492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/09/2021] [Accepted: 08/02/2021] [Indexed: 10/26/2022] Open
Abstract
A 34-year-old woman visited our hospital because she had had abdominal bloating for 2 months. She had been diagnosed with invasive thymoma (WHO pathological type B2), for which she had undergone chemotherapy and total thymectomy 10 years previously. Six years previously, pleural dissemination was diagnosed and she had undergone right extra-pleural pneumonectomy. On presentation to our hospital, abdominal computed tomography and ultrasound scans revealed abundant ascites and a huge liver lesion, likely a metastasis from her thymoma, obstructing the inferior vena cava. The serum-ascites albumin gradient was high at 1.4 g/dL, which indicated portal hypertension. We diagnosed Budd-Chiari syndrome caused by liver metastasis from a previous thymoma. Steroid therapy resulted in shrinkage of her liver tumor and a marked decrease in her ascites. Although rare, Budd-Chiari syndrome caused by liver metastasis from a thymoma is a possible serious complication of advanced invasive thymoma.
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Affiliation(s)
- Tomoya Horiguchi
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yoko Toyama
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yosuke Sakakibara
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Aki Ikeda
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hisashi Kako
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takuma Ina
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takuya Okamura
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Sakurako Uozu
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yasuhiro Goto
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kohei Yokoi
- Department of Thoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuyoshi Imaizumi
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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13
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Zu M, Xu K. Experts consensus on Chinese nomenclature of Budd-Chiari syndrome. J Interv Med 2021; 4:114-116. [PMID: 34826307 PMCID: PMC8562186 DOI: 10.1016/j.jimed.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 12/02/2022] Open
Abstract
In China, Budd-Chiari syndrome has been transliterated into six names according to the pronunciation of the letters. To standardize and unify the Chinese names of the disease, multi-disciplinary experts suggest translating Budd-Chiari syndrome into hepatic vein inferior venal cava obstruction syndrome as its Chinese name after reaching a consensus through discussion.
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Affiliation(s)
- Maoheng Zu
- Department of Interventional Radiology, The Affiliated Hospital of XuZhou Medical University, Xuzhou, 221000, China
| | - Ke Xu
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, 110000, China
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Comment on "The Value of Hepatic Vein Stent Placement as a Bridge Therapy on Treating Hepatic Alveolar Echinococcosis Presenting With Budd-Chiari Syndrome". Ann Surg 2021; 273:e157-e158. [PMID: 33491984 DOI: 10.1097/sla.0000000000004774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Klein-Weigel PF, Elitok S, Ruttloff A, Reinhold S, Nielitz J, Steindl J, Lutfi P, Rehmenklau-Bremer L, Hillner B, Fuchs H, Wrase C, Herold T, Beyer L. Inferior vena cava-syndrome. VASA 2021; 50:250-264. [PMID: 33459041 DOI: 10.1024/0301-1526/a000919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Inferior vena cava syndrome (IVCS) is caused by agenesis, compression, invasion, or thrombosis of the IVC, or may be associated with Budd-Chiari syndrome. Its incidence and prevalence are unknown. Benign IVCS is separated from malignant IVCS. Both cover a wide clinical spectrum reaching from asymptomatic to highly symptomatic cases correlated to the underlying cause, the acuity, the extent of the venous obstruction, and the recruitment and development of venous collateral circuits. Imaging is necessary to determine the underlying cause of IVCS and to guide clinical decisions. Interventional therapy has changed the therapeutic approach in symptomatic patients. This article provides an overview over IVCS and focuses on interventional therapeutic methods and results.
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Affiliation(s)
- Peter Franz Klein-Weigel
- Angiology - Interdisciplinary Center of Vascular Diseases, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Saban Elitok
- Nephrology, Endokrinology/Diabetology, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Andreas Ruttloff
- Angiology - Interdisciplinary Center of Vascular Diseases, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Sabine Reinhold
- Angiology - Interdisciplinary Center of Vascular Diseases, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Jessica Nielitz
- Angiology - Interdisciplinary Center of Vascular Diseases, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Julia Steindl
- Angiology - Interdisciplinary Center of Vascular Diseases, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Philippe Lutfi
- Angiology - Interdisciplinary Center of Vascular Diseases, Ernst von Bergmann Klinikum Potsdam, Germany
| | | | - Birgit Hillner
- Institute of Radiodiagnostic, Helios Klinikum Buch, Berlin, Germany
| | - Heiko Fuchs
- Diagnostic and Interventionel Radiology, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Christian Wrase
- Diagnostic and Interventionel Radiology, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Thomas Herold
- Institute of Radiodiagnostic, Helios Klinikum Buch, Berlin, Germany
| | - Lukas Beyer
- Diagnostic and Interventionel Radiology, Ernst von Bergmann Klinikum Potsdam, Germany
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Niknam R, Hajizadegan N, Mohammadkarimi V, Mahmoudi L. A study of the different parameters in acute and chronic Budd–Chiari syndrome. EGYPTIAN LIVER JOURNAL 2020. [DOI: 10.1186/s43066-020-00058-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Budd–Chiari syndrome (BCS) is a rare and potentially life-threatening vascular disease of the liver. There are a few studies on the differences between acute and chronic BCS in clinical and laboratory characteristics, as well as the outcomes, so we designed this research to study the different parameters in acute and chronic BCS. Diagnosis of BCS was made using Doppler ultrasound, magnetic resonance imaging, and venography. Patients with BCS were then divided into chronic and acute groups based on both imaging characteristics and disease duration. Finally, the outcomes, clinical features, and laboratory parameters of acute and chronic BCS were compared.
Results
In total, 60 patients were included in this study, of whom 28.3% and 71.7% had acute and chronic BCS, respectively. According to clinical features, spontaneous bacterial peritonitis (PR 1.289; 95% CI 1.115–1.489; P = 0.001) and jaundice (PR 1.308; 95% CI 1.148–1.490; P < 0.001) were significantly associated with chronic than acute BCS. According to laboratory parameters, the levels of international normalized ratio (INR) (PR 0.953; 95% CI 0.918–0.989; P = 0.012), blood urea nitrogen (BUN) (PR 0.996; 95% CI 0.993–1.000; P = 0.039), and model for end-stage liver disease (MELD) score (PR 1.024; 95% CI 1.012–1.037; P < 0.001) in chronic group were significantly higher than in the acute BCS. The hospital length of stay (LOS) and mortality rate between the two groups did not differ significantly.
Conclusions
This study showed that the spontaneous bacterial peritonitis, jaundice, increased levels of MELD score, INR, and BUN were significantly associated with the chronic group compared with the acute group. The hospital LOS and mortality rate between the two groups did not differ significantly. Further research is recommended to clarify this issue.
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Acute Budd-Chiari syndrome during hepatic vein catheterization. Radiol Case Rep 2020; 15:1853-1857. [PMID: 32817776 PMCID: PMC7426323 DOI: 10.1016/j.radcr.2020.07.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 01/14/2023] Open
Abstract
This case report describes a 4-year-old male with a history of hepatoblastoma, treated with chemotherapy followed by a right extended hepatectomy. Secondary to this, the patient experienced recurrent hepatic vein stenosis. He was treated initially with conventional angioplasty, followed by paclitaxel-coated balloon dilatations in an attempt to prevent episodes of re-stenosis. During the catheterization of the hepatic vein in one of the treatments, hemodynamic instability due to an acute Budd-Chiari syndrome occurred. The hemodynamic compromise became unresponsive to intravascular resuscitation and inotropic support. The patient was then treated with an emergency conventional angioplasty of the hepatic vein, which resulted in a rapid response and eventually in a full recovery. The etiology of this complication remains unclear; however, it may have been secondary to endothelial damage leading to acute thrombosis and/or venous spasm. Conventional angioplasty was successful in managing this complication. Awareness of iatrogenic acute Budd-Chiari syndrome as a potentially fatal complication during hepatic catheterization/dilatation, especially in the posthepatectomy setting, successful management of this complication, and the importance of a multidisciplinary and rapid response, is emphasized.
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García-Romero CS, Guzman C, Cervantes A, Cerbón M. Liver disease in pregnancy: Medical aspects and their implications for mother and child. Ann Hepatol 2020; 18:553-562. [PMID: 31126882 DOI: 10.1016/j.aohep.2019.04.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/15/2019] [Indexed: 02/04/2023]
Abstract
Liver disease during pregnancy is more common than expected and may require specialized intervention. It is important to determine if changes in liver physiology may develop into liver disease, to assure early diagnosis. For adequate surveillance of mother-fetus health outcome, liver disease during pregnancy might require intervention from a hepatologist. Liver diseases have a prevalence of at least 3% of all pregnancies in developed countries, and they are classified into two main categories: related to pregnancy; and those non- related that are present de novo or are preexisting chronic liver diseases. In this review we describe and discuss the main characteristics of those liver diseases associated with pregnancy and only some frequent pre-existing and co-incidental in pregnancy are considered. In addition to the literature review, we compiled the data of liver disease occurring during pregnancies attended at the National Institute of Perinatology in Mexico City in a three-year period. In our tertiary referral women hospital, liver disease was present in 11.24 % of all pregnancies. Associated liver disease was found in 10.8% of all pregnancies, mainly those related to pre-eclampsia (9.9% of pregnancies). Only 0.56% was due to liver disease that was co-incidental or preexisting; the acute or chronic hepatitis C virus was the most frequent in this group (0.12%). When managing pregnancy in referral hospitals in Latin America, it is important to discard liver alterations early for adequate follow up of the disease and to prevent adverse consequences for the mother and child.
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Affiliation(s)
| | - Carolina Guzman
- Laboratorio de Hígado, Páncreas y Motilidad, Unidad de Medicina Experimental, Facultad de Medicina, Universidad Nacional Autonoma de Mexico (UNAM)/Hospital General de México Dr. Eduardo Liceaga, Mexico City, Mexico
| | - Alicia Cervantes
- Servicio de Genética, Hospital General de México Dr. Eduardo Liceaga/Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.
| | - Marco Cerbón
- Unidad de Investigación en Reproducción Humana, Instituto Nacional de Perinatología-Facultad de Química, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
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Abstract
This study aims to report the Budd-Chiari syndrome clinical research status and progress that has occurred in over nearly 30 years in China, and emphasize the value of imaging in facilitating the diagnosis of Budd-Chiari syndrome based on more than 2500 cases. Findings on ultrasonography, computed tomography, magnetic resonance imaging, and digital subtraction angiography images are used to propose new Budd-Chiari syndrome types and subtypes. The new subtype classification presented here has important value for guiding interventional treatment. This study also proposes a new concept of anatomical and functional obstruction of hepatic vein that stresses the compensatory value of accessory hepatic vein and azygos vein and describes the risk of manipulation of the communication branch of inferior vena cava obstruction in interventional therapy.
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Gupta P, Bansal V, Kumar-M P, Sinha SK, Samanta J, Mandavdhare H, Sharma V, Dutta U, Kochhar R. Diagnostic accuracy of Doppler ultrasound, CT and MRI in Budd Chiari syndrome: systematic review and meta-analysis. Br J Radiol 2020; 93:20190847. [PMID: 32150462 DOI: 10.1259/bjr.20190847] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To evaluate the sensitivity, specificity, and diagnostic odds ratio (DOR) of Doppler ultrasound, CT, and MRI in the diagnosis of Budd Chiari syndrome (BCS). METHODS We performed a literature search in PubMed, Embase, and Scopus to identify articles reporting the diagnostic accuracy of Doppler ultrasound, CT, and MRI (either alone or in combination) for BCS using catheter venography or surgery as the reference standard. The quality of the included articles was assessed by using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. RESULTS 11 studies were found eligible for inclusion. Pooled sensitivities and specificities of Doppler ultrasound were 89% [95% confidence interval (CI), 81-94%, I2 = 24.7%] and 68% (95% CI, 3-99%, I2 = 95.2%), respectively. Regarding CT, the pooled sensitivities and specificities were 89% (95% CI, 77-95%, I2 = 78.6%) and 72% (95% CI, 21-96%, I2 = 91.4%), respectively. The pooled sensitivities and specificities of MRI were 93% (95% CI, 89-96%, I2 = 10.6%) and 55% (95% CI, 5-96%, I2 = 87.6%), respectively. The pooled DOR for Doppler ultrasound, CT, and MRI were 10.19 (95% CI: 1.5, 69.2), 14.57 (95% CI: 1.13, 187.37), and 20.42 (95% CI: 1.78, 234.65), respectively. The higher DOR of MRI than that of Doppler ultrasound and CT shows the better discriminatory power. The area under the curve for MRI was 90.8% compared with 88.4% for CT and 86.6% for Doppler ultrasound. CONCLUSION Doppler ultrasound, CT and MRI had high overall diagnostic accuracy for diagnosis of BCS, but substantial heterogeneity was found. Prospective studies are needed to investigate diagnostic performance of these imaging modalities. ADVANCES IN KNOWLEDGE MRI and CT have the highest meta-analytic sensitivity and specificity, respectively for the diagnosis of BCS. Also, MRI has the highest area under curve for the diagnosis of BCS.
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Affiliation(s)
- Pankaj Gupta
- Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Varun Bansal
- Departments of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | | | | | | | | | - Usha Dutta
- Gastroenterology, PGIMER, Chandigarh, India
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Abstract
Venous leg ulcers are a manifestation of lower extremity chronic venous disorder. Venous hypertension caused by abnormal venous blood flow is considered to be the primary mechanism of venous ulcers. The etiology of lower extremity venous ulcer is complicated, and it is difficult to be treated. At present, it has achieved a certain effect for venous leg ulcers through the combination of drugs, pressure therapy, and surgical treatment. Budd-Chiari syndrome is a rare syndrome characterized by portal hypertension and/or inferior vena cava syndrome. Treatment of Budd-Chiari syndrome includes anticoagulation, thrombolysis, angioplasty, stenting, transjugular intrahepatic portosystemic shunt, and liver transplantation. This article reports an elderly female patient with recurrent ulceration of both lower extremities that healed poorly after long-term dressing and skin grafting. During further examination, she was found to have Budd-Chiari syndrome. Through multidisciplinary treatment, which includes removing the inferior vena cava stenosis and implanting the ulcer wound, the ulcer wounds then healed.
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Affiliation(s)
- Wei Zhu
- Southwest Hospital, Army Medical University, Chongqing, China
| | - Huapei Song
- Southwest Hospital, Army Medical University, Chongqing, China
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Kim JH, Baek JH. Transient Budd-Chiari syndrome as an unpredictable complication of supradiaphragmatic inferior vena cava reconstruction after blunt thoracic trauma: A case report. Medicine (Baltimore) 2019; 98:e15821. [PMID: 31145318 PMCID: PMC6708969 DOI: 10.1097/md.0000000000015821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Supradiaphragmatic inferior vena cava (IVC) injury due to blunt thoracic trauma is extremely rare. Budd-Chiari syndrome (BCS) is also rare and presents with ascites, abdominal pain, hepatomegaly, leg swelling, and jaundice. Its etiology is diverse, and it is rarely caused by trauma. PATIENT CONCERNS A 36-year-old man with blunt trauma from a traffic accident presented with chest pain. Chest computed (CT) and emergency surgery with CPB revealed completely transected supradiaphragmatic inferior vena cava (IVC), which reconstruction was essential. DIAGNOSES BCS caused by impaired hepatic venous drainage through a reconstructed neo-IVC after severe blunt trauma injury to the supradiaphragmatic IVC was diagnosed. INTERVENTION Hepatic failure, ascites, leg swelling, and jaundice were resolved post-insertion of a veno-venous extracorporeal membrane oxygenator (V-V ECMO) for hepatic venous drainage, but these clinical symptoms reappeared after ECMO removal. OUTCOME The patient died from rapidly progressing sepsis, pneumonia, and acute renal failure during repeated insertion of ECMO and weaning off ECMO. LESSONS Reconstructing and improving the patency of the supradiaphragmatic IVC is essential for successful hepatic venous drainage. Additionally, a surgical strategy focused on graft selection can prevent kinking stenosis, and possibly BCS, especially in emergency surgeries. A ring-supported synthetic graft should be considered an alternative to improve long-term patency and survival rate.
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Affiliation(s)
- Jung Hee Kim
- Department of Thoracic and Cardiovascular Surgery, The Daegu Veterans Medical center
| | - Jong Hyun Baek
- Department of Thoracic & Cardiovascular Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Galas M, Glówczyńska R, Lewandowski Z, Cacko A, Raszeja-Wyszomirska J, Milkiewicz P, Krawczyk M, Zieniewicz K, Opolski G. Etiology of Liver Disease and Cardiovascular Abnormalities in Patients on a Liver Transplantation Waiting List. Ann Transplant 2019; 24:162-167. [PMID: 30898994 PMCID: PMC6442494 DOI: 10.12659/aot.913061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The classical cardiovascular risk factors and changes in the circulatory system secondary to end-stage liver disease (ESLD) are associated with an increased risk of cardiac abnormalities (CAs) in patients waiting for liver transplantation (LTx). The aim of this study was to assess the relationship between the etiology of liver disease and the presence of CAs in patients qualified for LTx. MATERIAL AND METHODS The study enrolled patients qualified to LTx due to ESLD at the Clinical Hospital of the Medical University of Warsaw between 2013 and 2016. Out of 396 patients: 65, 157, 117, and 57 had ESLD due to the alcoholic liver disease (ALD), viral infections (VIR), autoimmune disorders (AUTO), and different etiologies (OTHER), respectively. RESULTS An increased frequency of hypertension and diabetes mellitus were observed in ALD and VIR groups, while for hyperlipidemia, the highest rates were observed in ALD and AUTO groups. Significant differences in CAs rates were observed for resting tachycardia, prolonged QT interval, bradycardia, and left ventricular diastolic dysfunction. After adjustment for age, MELD, and Child-Pugh scores, hyperlipidemia (26% vs. 7-15%, p<0.048) was most frequently observed in the AUTO group, while poor aerobic capacity (49% vs. 21-34%, p<0.009) dominated in the OTHER group. CONCLUSIONS The frequency of hyperlipidemia, and poor aerobic capacity were directly related to the etiology of liver disease, while the remaining associations resulted from effects of age, MELD, and Child-Pugh score.
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Affiliation(s)
- Michalina Galas
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Renata Glówczyńska
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Zbigniew Lewandowski
- Department of Epidemiology and Biostatistics, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Cacko
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland
| | - Joanna Raszeja-Wyszomirska
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Milkiewicz
- Liver and Internal Medicine Unit, Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Marek Krawczyk
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Zieniewicz
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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Abdominal pain, nausea, vomiting, and ascites in a 14-year-old girl with systemic lupus erythematosus: Answers. Pediatr Nephrol 2019; 34:431-433. [PMID: 30187126 DOI: 10.1007/s00467-018-4059-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/01/2018] [Accepted: 08/13/2018] [Indexed: 10/28/2022]
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Bansal V, Gupta P, Sinha S, Dhaka N, Kalra N, Vijayvergiya R, Dutta U, Kochhar R. Budd-Chiari syndrome: imaging review. Br J Radiol 2018; 91:20180441. [PMID: 30004805 DOI: 10.1259/bjr.20180441] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Budd-Chiari syndrome (BCS), also known as hepatic venous outflow tract obstruction includes a group of conditions characterized by obstruction to the outflow of blood from the liver secondary to involvement of one or more hepatic veins (HVs), inferior vena cava (IVC) or the right atrium. There are a number of conditions that lead to BCS-ranging from hypercoagulable states to malignancies. In up to 25% patients, no underlying disorder is identified. Diagnosis of BCS is based on a combination of clinical and imaging features. A major part of the literature in BCS has been devoted to interventions; however, a detailed description of various imaging manifestations of BCS is lacking. In this review, we highlight the importance of various imaging modalities in the diagnosis of BCS.
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Affiliation(s)
- Varun Bansal
- 1 Department of Radiodiagnosis and Imaging, Postgraduate Institute ofMedical Imaging and Research (PGIMER) , Chandigarh , India
| | - Pankaj Gupta
- 2 Deapartment of Gastroenterology, Postgraduate Institue of Medical Education and Research , Chandigarh , India
| | - Saroj Sinha
- 2 Deapartment of Gastroenterology, Postgraduate Institue of Medical Education and Research , Chandigarh , India
| | - Narender Dhaka
- 2 Deapartment of Gastroenterology, Postgraduate Institue of Medical Education and Research , Chandigarh , India
| | - Naveen Kalra
- 1 Department of Radiodiagnosis and Imaging, Postgraduate Institute ofMedical Imaging and Research (PGIMER) , Chandigarh , India
| | - Rajesh Vijayvergiya
- 3 Department of Cardiology, Postgraduate Institute of Medical Education and Research , Chandigarh , India
| | - Usha Dutta
- 2 Deapartment of Gastroenterology, Postgraduate Institue of Medical Education and Research , Chandigarh , India
| | - Rakesh Kochhar
- 2 Deapartment of Gastroenterology, Postgraduate Institue of Medical Education and Research , Chandigarh , India
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