Sonographic Criteria of Budd-Chiari Syndrome

Budd-Chiari syndrome (BCS) is a rare liver disease defined as obstruction of the hepatic venous outflow. Numerous case reports illustrate the possibilities of imaging in individual patients, but systematic data processing to optimize the diagnostic approach in BCS is lacking. This study aims at identifying diagnostic ultrasound criteria for BCS diagnosis in a multicenter-cohort with 63 patients from Germany (n=20), Italy (n=15) and China (n=28).

The mean age of all patients was 43.7 years. Symptoms were mostly unspecific in the Chinese and the German cohort, but everyone was symptomatic. In the Italian group, 27% were asymptomatic.

In the whole sample, thrombus localisation was distributed equally (thrombus in right hepatic vein 35%, left hepatic vein 33%, middle hepatic vein (MHV) 27%, Vena cava inferior (VCI) 35% and Confluence 22%). In the Chinese sample, thrombosis of the VCI was the most frequent localisation (71%) whereas in Italy, thrombus of the MHV (57%) and in Germany, thrombus of the Confluence area (60%) where the most frequent localisations. BCS mostly occurred in a chronic course (82%). Portal venous thrombosis was present in 8 cases (15%), none in the Chinese group. The liver presented mostly enlarged, 7 cases in China showed a smaller liver size. Vascular collaterals were visualizable in 93%. The collaterals were localized intra-and extrahepatically in 51%, in 36% they were only present intrahepatically.

In this study, sonographic signs of BCS were evaluated in patients from different continents for the first time. Patients differ in symptoms and disease manifestations in the different subgroups.

Publication History

Article published online:
26 January 2022