Budd-Chiari Syndrome with Obstruction of the Inferior Vena Cava

Chronic Budd-Chiari syndrome due to obstruction of the intrahepatic portion of the inferior vena cava

“…The diagnosis of inferior vena cava obstruction should be considered in all cases of the Budd-Chiari syndrome even without obvious signs, as such patients without visible or significant abdominal venous collaterals have been reported (Davis et al, 1968;Yamamoto et al, 1968). This point has been well illustrated in our case 3 where visible abdominal venous collaterals were insignificant yet the hepatography and vena caval catheterization showed an obstruction in the inferior vena cava.…”

“…In fact the diagnosis of the Budd-Chiari syndrome today should appropriately be qualified as due to obstruction of the main hepatic veins, obstruction of the hepatic portion of the inferior vena cava (partial or complete), or both. As the isolated obstructive lesions of the inferior vena cava in the hepatic portion have been found to be amenable to surgery with encouraging results (Yamamoto et al, 1968), the recognition of the appropriate site of obstruction is of great practical importance. The wide clinical spectrum and natural history of such cases have been reviewed by Nakamura et al (1968).…”

“…It is of interest that five of our 11 patients had the clinical, radiological, and haemodynamic similarity to the cases described as membranous obstruction of the inferior vena cava in the hepatic portion (Kimura et al, 1963). One of the patients (case 3) corresponds with 'type A', partial obstruction, and the rest belong to 'type B', complete membranous obstruction of the inferior vena cava as described by Yamamoto et al (1968). It is likely, therefore, that the greater awareness of the syndrome, coupled with the applicability ofimproved techniques of investigation, might reveal that such patients are not exclusive to any particular geographical distribution but may have a worldwide occurrence.…”

“…Liver biopsy studied in these reports has shown haemorrhage in hepatic parenchyma and congestion in cases with a short illness and cirrhosis in patients with a long illness. It is important to differentiate these cases from those of the Budd-Chiari syndrome due to hepatic vein pathology as these membranous defects can be dealt with surgically (Yamamoto et al, 1968).…”

Partially Obstructed Hepatic Portion of Inferior Vena Cava Diagnosed by Percutaneous Hepatography Inferior Venacava Obstruction

“…However, it is now well known that Budd Chiari syndrome may also occasionally be due to the obstructive lesion of the hepatic portion of the inferior vena cava. Such cases have been reported from Japan (4,5) United States of America (6,7), England (8), Africa (9), New Zealand (10) and India (11). With the use of haemodynamic studies, venous catheterization, cavographic and hepatographic techniques it is now possible to diagnose the exact site of obstruction.…”