Diagnosis of the cavo-hepato-atrial pathway in Budd-Chiari syndrome by ultrasonography

Abstract

The aim of this study was to investigate the ultrasonic features of the cavo-hepato-atrial pathway in Budd-Chiari syndrome (BCS), by which blood is drained from the occluded inferior vena cava (IVC) to the right atrium via hepatic veins. Ultrasonograms from 11 patients with BCS with cavo-hepato-atrial pathways were retrospectively studied. Doppler ultrasound was used to observe the direction of the flow and measure the velocity of the blood-draining vessels. Blood flow in the draining vessels and the collaterals was shown as blue, red or bicolored depending on whether the flow direction was away from the transducer, towards the transducer or both. For measurement, the Doppler angle between the axis of the Doppler beam and that of the vein examined was always <60°. Ultrasonography was performed 1–2 weeks prior to digital subtraction angiography (DSA). All patients were confirmed by DSA. Membranous and segmental occlusions of IVCs were observed in seven and four cases, respectively. Blood flow from the IVC reversed to the hepatic/accessory hepatic vein, continued through the dilated intrahepatic collaterals, onward to the other hepatic vein and finally to the right atrium. The majority of the inlets (8/11) of hepatic veins above the occlusion were narrow compared with the dilated distant parts of the lumens. Accelerated blood flow in the inlets was detected in all patients regardless of the luminal diameter. In conclusion, the results from the present study suggest that the unusual cavo-hepato-atrial pathway can be diagnosed reliably by ultrasonography, which may be useful for clinical management.

Ultrasonographic Visualization of Accessory Hepatic Veins and Their Lesions in Budd–Chiari Syndrome

“…Reversed blood flow in the AHVs was observed in 7 patients with a cavo-hepato-atrial pathway in which the IVC was occluded between the patent AHV and hepatic vein; venous flow from the IVC reversed to the AHV and intrahepatic communicating branches, onward to a hepatic vein and finally to the right atrium, as reported previously (Gai et al 2014a). Blood from the septal occluded inferior right hepatic vein and the caudate lobe vein of the patients did not enter the IVC, but drained into the right hepatic subcapsular vein (Fig.…”

“…This blood-draining pathway relieves the symptoms caused by portal hypertension and IVC hypertension (Akaki et al 1995;Kamba et al 1995;Takayasu et al 1985). Hepatopetal flow in AHVs can be clearly observed on ultrasonography, on which basis a definite diagnosis can be made (Gai et al 2014a(Gai et al , 2014b.…”

Computed tomography angiography manifestations of collateral circulations in Budd-Chiari syndrome

“…The intrahepatic blood drainage route is the shortest pathway with the lowest resistance. Furthermore, the IVC-HV/accessory HV-HV-right atrium collateral can efficiently compensate the outflow of the IVC to the heart, as shown in the literature ( 13 , 14 ) and in our previous study ( 15 ). The pathology underlying this type of collateral is that the blood pressure below the obstruction of the IVC exceeds that of the HVs, and blood from the IVC reverses through the intrahepatic collaterals to the right atrium.…”