Familial Budd Chiari disease: angiographic study in two sisters

Review article: the aetiology of primary Budd-Chiari syndrome - differences between the West and China

BACKGROUND

China may have the largest number of Budd-Chiari syndrome (BCS) cases in the world (at least 1914 original papers were published, and at least 20 191 BCS patients were reported). Considering the discrepancy in the clinical profiles and preferred treatment selection of primary BCS between the West and China, understanding its aetiology in these two different regions is very important.

AIM

To review the data from large cohort studies and meta-analyses to illustrate the epidemiology of risk factors for BCS in the West and China.

METHODS

Relevant papers were identified by major English- and Chinese-language databases, conference abstracts, and by manual search.

RESULTS

Risk factors reviewed include myeloproliferative neoplasms (MPNs) and their related gene mutations, anti-phospholipid syndrome, paroxysmal nocturnal haemoglobinuria (PNH), hyperhomocysteinaemia and 5,10-methylenetetrahydrofolate reductase (MTHFR) C677T mutation, factor V Leiden (FVL) and prothrombin G20210A mutations, inherited anti-thrombin, protein C and protein S deficiencies, pregnancy and puerperium, poverty, and family history.

CONCLUSIONS

We examined the differences in the aetiological distribution of BCS between the West and China. Several recommendations should be considered in Chinese BCS patients: (i) screening for hyperhomocysteinaemia and MTHFR mutation should be regularly performed; (ii) screening for MPNs, PNH, and anti-phospholipid syndrome should be selectively performed; (iii) inherited anti-thrombin, protein C, and protein S deficiencies should be actively explored; (iv) screening for FVL and prothrombin G20210A mutations may be unnecessary; and (v) the clinical significance of pregnancy and puerperium, poverty with bacterial infections and unsanitary environments, and family history as possible risk factors should never be neglected.

Sonography of caudal hepatic veins in children. Incidence, importance and relation to cranial hepatic veins

In 200 unselected upper abdominal sonographies in children the hepatic venous anatomy was examined with special reference to caudal hepatic veins. In 42% of patients caudal hepatic veins could be demonstrated sonographically, while large caudal hepatic veins could be shown in 12.5% of patients. The large caudal hepatic veins always drained from the posterior-inferior or posterior-lateral parts of the liver complementing the right (cranial) hepatic vein. When the size of the right cranial hepatic vein was small the caudal hepatic vein(s) were large. Sonographic demonstration of a small right hepatic vein is a useful indicator of large caudal hepatic veins, and the relative sizes of the cranial and caudal veins are inversely proportional.