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Vascular » Visceral vascular
Budd Chiari syndrome
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Presentation A 12 year old boy presented with a history of jaundice and distension of the abdomen. The patient was hospitalized elsewhere for hepatic encephalopathy and sepsis. He had been tapped repeatedly for ascites but had felt no relief.
Caption: Oblique scans of the liver
Description: The right and middle hepatic veins are visualized here. They are barely discernible and appear cord-like with some echogenic material within. A right sided pleural effusion is also noted.
Caption: Oblique color Doppler image
Description: The right hepatic vein shows no color flow at all.
Caption: Transverse image of the left lobe of the liver
Description: The left hepatic vein is also almost cord-like and is barely visible.
Caption: Color Doppler image of the IVC
Description: Ascites is noted. The IVC appears patent.
Differential Diagnosis Budd Chiari syndrome
Final Diagnosis Budd Chiari syndrome
Follow Up Mesocaval shunt surgery was performed. A patent shunt was seen. Hepato- fugal flow was seen in the portal vein (indirect sign) of shunt patency, but there was no relief in the ascitic fluid, which kept draining 2 liters of fluid daily. The patient died  three and a half months after surgery.
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