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Sonar N, Sadiq Z, Kaur G, Pervaze S, Cook N. A Case of Budd-Chiari Syndrome Secondary to Tumor Thrombosis. Cureus 2024; 16:e55330. [PMID: 38562314 PMCID: PMC10982124 DOI: 10.7759/cureus.55330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Budd-Chiari syndrome (BCS) is a rare constellation of conditions due to obstruction of venous flow from anatomical levels ranging from the hepatic veins to the confluence of the inferior vena cava (IVC) and right atrium. The resulting retrograde flow of blood leads to hepatomegaly, ascites, and liver failure among other features. Our case highlights the clinical features, diagnostic challenges, and management of a patient with a tumor thrombus from a metastatic prostate adenocarcinoma in a 67-year-old male leading to BCS. This patient, with a past history of prostate adenocarcinoma and aortic valve replacement on chronic warfarin anticoagulation, presented with acutely worsening abdominal pain and a distended abdomen, and imaging revealed an IVC filling defect. Subsequent imaging with a piflufolastat prostate-specific PET showing increased uptake in the IVC elucidated the diagnosis of tumor thrombosis. Management considerations include aggressive therapy and optimization of quality of life. The patient was offered both options, and options including surgical shunting, bypasses, and anticoagulation were discussed. After shared decision-making, the patient and family opted to choose the pathway of palliative radiation and anticoagulation.
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Affiliation(s)
- Nirmay Sonar
- Internal Medicine, Norton Community Hospital, Norton, USA
- Internal Medicine, Ballad Health, Norton, USA
| | - Zaynah Sadiq
- Internal Medicine, Norton Community Hospital, Norton, USA
| | - Gurvinder Kaur
- Internal Medicine, Norton Community Hospital, Norton, USA
| | - Shohan Pervaze
- Internal Medicine, Norton Community Hospital, Norton, USA
| | - Nicholas Cook
- Hematology and Oncology, Norton Community Hospital, Norton, USA
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2
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Zaher EA, Ebrahim MA, Patel P, Eshan SH, Alvi MS. A Rare Association of Epstein-Barr Virus and Budd-Chiari Syndrome. Cureus 2024; 16:e52323. [PMID: 38361703 PMCID: PMC10867698 DOI: 10.7759/cureus.52323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
Budd-Chiari syndrome (BCS) is a rare hepatic venous outflow obstruction typically associated with hypercoagulable states. We present a unique case of a 29-year-old male with BCS triggered by a recent Epstein-Barr virus (EBV) infection. Workup unveiled antiphospholipid antibody syndrome as an underlying prothrombotic condition. Diagnostic challenges included inconclusive ultrasound findings, necessitating magnetic resonance imaging for confirmation. This case underscores the importance of considering infectious triggers for venous thromboembolism in BCS. Understanding the potential link between EBV and thrombosis warrants further investigation.
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Affiliation(s)
- Eli A Zaher
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
| | | | - Parth Patel
- Internal Medicine, Ascension Saint Joseph Hospital, Chicago, USA
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3
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Behera SK, Behera P, Behera JR, Behera G. Study of Cardiac Dysfunction in Portal Hypertension: A Single-Center Experience From Eastern India. Cureus 2023; 15:e51259. [PMID: 38283536 PMCID: PMC10822045 DOI: 10.7759/cureus.51259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/30/2024] Open
Abstract
INTRODUCTION Cardiac functional abnormalities are common in patients with cirrhosis of the liver. Nonetheless, the effect of portal hypertension and liver disorder on cardiac abnormalities is yet to be investigated. The current study evaluated the contribution of cirrhotic and non-cirrhotic portal hypertension as the potential cause of cardiac abnormalities. METHODS The present study was a cross-sectional observational study. After excluding known heart diseases, 128 patients with portal hypertension from different causes were enrolled in the study. Cardiac functional activity was assessed by electrocardiogram (ECG) and transthoracic echocardiography (TTE). Results: This study included a total of 128 patients, out of which 24 had extrahepatic portal vein obstruction (EHPVO), four patients had Budd-Chiari syndrome and 100 had liver cirrhosis. Normal ventricular function was observed in patients with EHPVO and Budd-Chiari syndrome. Sixty-eight percent of cases had liver cirrhosis diastolic abnormalities. The mean QTc interval in patients with cirrhotic cardiomyopathy (CCM) was 0.49 ± 0.05 sec which was significantly increased when compared to patients without CCM with 0.432 ± 0.07 at p=0.0016. The Child Turcotte Pugh (CTP) score and MELD (Model for End-Stage Liver Disease) score in patients with CCM were significantly higher as compared to patients without CCM. All alcoholic cirrhotic and non-alcoholic cirrhotic patients had equal prevalence of diastolic dysfunction (p-value >0.05). CONCLUSION Patients with Child class C or a high MELD score are associated with a higher prevalence rate of CCM while normal cardiac function was observed among patients having portal hypertension due to extrahepatic causes. We recommend cardiac evaluation by echocardiography in all cirrhotic patients. Institution of specific medical therapy and early referral for liver transplantation should be considered to improve survival in patients with decompensated cirrhosis.
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Affiliation(s)
- Sambit Kumar Behera
- Gastroenterology, Srirama Chandra Bhanja (SCB) Medical College, Cuttack, IND
| | - Prajyoti Behera
- Physiology, Institute of Medical Sciences (IMS) & SUM Hospital, Bhubaneswar, IND
| | | | - Gayatri Behera
- Pathology, Institute of Medical Sciences (IMS) & SUM Hospital, Bhubaneswar, IND
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4
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Fujiwara K, Kondo T, Fujimoto K, Koizumi J, Kato N. Percutaneous Transhepatic Direct Portosystemic Shunt for a Patient With Budd-Chiari Syndrome Using a Balloon as a Target in a Stenotic Inferior Vena Cava. Cureus 2023; 15:e44967. [PMID: 37822436 PMCID: PMC10562881 DOI: 10.7759/cureus.44967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2023] [Indexed: 10/13/2023] Open
Abstract
Budd-Chiari syndrome (BCS) patients with portal hypertension are often treated with a direct intrahepatic portosystemic shunt (DIPS) or transjugular intrahepatic portosystemic shunt (TIPS) and angioplasty. DIPS can be problematic, however, due to the technical difficulty of the procedure. To address this problem, we describe a method using the balloon used for inferior vena cava (IVC) dilatation as a puncture target to safely perform DIPS in a BCS patient with complete hepatic vein occlusion and stenosis of the IVC. To perform balloon dilation, the puncture is made through the internal jugular vein, and the guidewire is advanced to the IVC with stenosis. After dilatation of the IVC, the direct left lateral subdistrict branch of the portal vein is percutaneously punctured directly from the cardiac fossa (targeting the inflated balloon in the IVC), and the IVC puncture is done through the portal vein. After creating a pull-through route, a stent is placed between the left portal vein and the IVC. The procedure is completed without any complications. This technique has the potential to form the basis of a safe and reliable DIPS procedure.
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Affiliation(s)
| | | | | | | | - Naoya Kato
- Gastroenterology, Chiba University, Chiba, JPN
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5
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Camões Neves J, Rodrigues F, Apolinário I, Alves M, Sousa Caetano O. Budd-Chiari Syndrome Caused by Polycythemia Vera: A Case Report. Cureus 2023; 15:e45527. [PMID: 37868390 PMCID: PMC10585603 DOI: 10.7759/cureus.45527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Budd-Chiari syndrome (BCS) is a rare condition characterized by the obstruction of hepatic venous outflow. It has various potential etiologies, with myeloproliferative neoplasms representing the most prevalent pathogenic association. Here, we present the case of a 51-year-old male who manifested abdominal pain and ascites. Subsequent clinical investigation revealed the presence of BCS secondary to a myeloproliferative syndrome, specifically polycythemia vera. This case emphasizes the importance of diagnosing BCS and conducting a thorough investigation into its underlying etiology.
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Affiliation(s)
| | | | | | - Marina Alves
- Internal Medicine, Hospital de Braga, Braga, PRT
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6
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Gupta J, Chaudhari K, Dave A, B M. Successful Pregnancy Outcome in an Operated Case of Budd-Chiari Syndrome Having Fetal Growth Restriction: A Twisted Tale of Gravid. Cureus 2023; 15:e42745. [PMID: 37654912 PMCID: PMC10467606 DOI: 10.7759/cureus.42745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 07/31/2023] [Indexed: 09/02/2023] Open
Abstract
Budd-Chiari Syndrome (BCS) primarily affects women in the reproductive age group, with an ever-increasing incidence in the general population. Due to its rarity, it is not known precisely how a pregnancy progresses in a woman with BCS and what can happen to the baby. A rare condition known as Budd-Chiari syndrome causes the hepatic veins in the liver to constrict and become blocked. The challenges in pregnancy, such as decreasing hepatic function, a rise in thrombotic and bleeding events, or ascites, have historically made pregnancy inappropriate in these people. Here, we present a case of an unbooked 24-year-old female, a known case of treated BCS with 36 weeks and three days gestation period. She was referred from a peripheral hospital to our hospital's emergency department because of having fetal growth restriction. By presenting this rare case, we expect more extensive studies will be conducted on the effect of pregnancy on BCS and the effect of BCS on pregnancy which will help obstetricians to turn this rare possibility of conception into a fair possibility.
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Affiliation(s)
- Jatin Gupta
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Kamlesh Chaudhari
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Apoorva Dave
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Mounica B
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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7
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Agrawal D, Gupta D, Nathani R, Dhore P, Meshram M, Bhatia SJ, Shukla A. Presence of Ascites at Presentation is Associated With Absence of Long-Term Response Amongst Patients With Budd-Chiari Syndrome When Treated With Medical Therapy Alone: A Single Centre Real-Life Experience. J Clin Exp Hepatol 2022; 12:861-870. [PMID: 35677520 PMCID: PMC9168723 DOI: 10.1016/j.jceh.2021.10.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 10/27/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND There is lack of data on long-term outcomes of patients with Budd-Chairi Syndrome (BCS) treated with medical therapy including anticoagulation alone. METHODS Consecutive patients (N = 138, mean [standard deviation, SD] age 29.3 [12.9] years; 66 men) with BCS, treated with medical therapy alone including anticoagulation, with minimum follow-up of 12 months were included. Initial response was classified as complete (CR), partial (PR) or nonresponse (NR) and on follow-up as loss of response (LoR) or maintenance of response (MoR). The association of baseline, clinical and biochemical parameters with different responses was evaluated. RESULTS Seventy-six patients (55.1%) had CR, 26 (18.8%) had PR and 36 (26.1%) had NR. None with PR or NR had CR later. At a median follow-up of 40 (range 12-174) months, LoR was more common in PR group than in CR group (12 [46.2%] vs 18 [23.7%], P = 0.03). LoR was associated with presence of ascites (odds ratio [OR] 1.5; 95% confidence interval [CI] 0.06-0.71), gastrointestinal bleed (OR 1.33; 95% CI 0.09-0.82) or jaundice (OR 1.01; 95% CI 0.11-0.97) at baseline and duration of follow-up (OR 0.018; 95% CI 1.006-1.030). Mortality was higher in NR (28 [77.8%]) compared with CR (15 [19.7%], P = 0.001) and PR (8 [30.8%], P = 0.001). On binary logistic regression analysis, presence of ascites at baseline was associated with LoR (OR 0.303 [0.098-0.931]). CONCLUSION Patients with initial CR have better survival than nonresponders. One-third had LoR on follow-up. The presence of ascites at baseline is associated with LoR.
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Key Words
- AC-BCS, Acute on chronic BCS
- BCS, Budd-Chairi Syndrome
- CR, Complete response
- CTP, Child-Pugh score
- EVL, Endoscopic variceal band ligation
- GAVE, Gastric antral vascular ectasia
- GI, gastrointestinal
- GOV1/2, Gastroesophageal varices 1 and 2
- HVOTO, Hepatic venous outflow tract obstruction
- INR, International Normalised Ratio
- IVC, inferior vena cava thrombosis
- LMWH, low-molecular-weight heparin
- LoR, Loss of response
- MELD, Model for end stage liver disease
- MoR, Maintenance of response
- NR, Nonresponse
- PHG, portal hypertensive gastropathy
- PR, Partial response
- SBP, Spontaneous bacterial peritonitis
- Warfarin
- budd-chiari syndrome
- cirrhosis
- portal hypertension
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Affiliation(s)
| | | | | | | | | | | | - Akash Shukla
- Address for correspondence: Akash Shukla, Department of Gastroenterology, New building 11th floor, Seth GS Medical College and KEM Hospital, Mumbai 400012, India.
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Gonçalves A. Primary Budd-Chiari Syndrome With Right Atrial Extension: A Rare Presentation of Intrahepatic Cholangiocarcinoma. Cureus 2021; 13:e18935. [PMID: 34812319 PMCID: PMC8604428 DOI: 10.7759/cureus.18935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 11/05/2022] Open
Abstract
Budd-Chiari syndrome (BCS) is defined as hepatic venous outflow obstruction and can be classified as primary when the obstruction is due to a predominantly venous process, caused by multiple risk factors that lead to a prothrombotic state. We report a case of a primary BCS, with an exuberant thrombus extending from the supra-hepatic vein, via the inferior vena cava, to the right atrium, a rare form of presentation of intrahepatic cholangiocarcinoma (ICC).
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Affiliation(s)
- Ana Gonçalves
- Internal Medicine, Hospital Fernando Fonseca, Amadora, PRT
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9
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Wang C, Qiu Y, Wang W. Application of ex vivo liver resection and autotransplantation in treating Budd-Chiari syndrome secondary to end-stage hepatic alveolar echinococcosis: A case series. Medicine (Baltimore) 2021; 100:e27075. [PMID: 34449508 PMCID: PMC8389916 DOI: 10.1097/md.0000000000027075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 08/12/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Secondary Budd-Chiari syndrome (BCS) occurs due to a blockage in the liver caused by invasion or compression by a large lesion. Conventional treatments for BCS do not solve practical problems, wherease liver transplantation has been only applied as a last-resort therapy and as the only opportunity for a radical cure. We explored the feasibility of applying ex vivo liver resection and autotransplantation (ELRA) for the new indications of treating patients with end-stage hepatic alveolar echinococcosis (HAE). Our center has firstly proposed the idea and successfully treated the 49 patients with HAE. This article for the first time reports the application of ELRA in treating patients with BCS secondary to HAE. METHODS According to the degree of lesion invasion and surgical options, 11 patients were divided into 4 types. These 11 patients had large lesions that invaded the second and third hilum of the caudate lobe and involved the confluence of the hepatic vein and the inferior vena cava, suprahepatic vena cava, or at least 2 hepatic veins and led to secondary BCS. The aim of the present work was to report 11 patients with life-threatening diseases who underwent ELRA (ex vivo liver resection and autotransplantation) for secondary BCS, to propose a classification system for secondary BCS, and to suggest that secondary BCS is an indication for ELRA. RESULTS Eleven patients successfully underwent ELRA without intraoperative mortality. The median autograft weight was 690 g (440-950 g); operative time was 12.5 hours (9.4-16.5 hours); Postoperative hospital stay was 15 days (7-21 days). Clavien-Dindo grade IIIa or higher postoperative complications occurred in only 5 patients. CONCLUSIONS This article for the first time reports the application of ELRA in treating patients with BCS secondary to HAE, not only provides new ideas for alternative treatments of secondary BCS, but also provides a classification system for secondary BCS. This article describes the technical process of outflow tract reconstruction and the experience for expanding the indications for ELRA. Our study demonstrated that ELRA is well feasible for treatment of BCS secondary to advanced HAE.
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Affiliation(s)
- Cong Wang
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province
- Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Xining, Qinghai Province, China
| | - Yiwen Qiu
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province
| | - WenTao Wang
- Department of Liver Surgery, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu, Sichuan Province
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10
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Timsaal Y, Ali SH, Malik F, Chawla A, Ahmed J. Rare Case of Budd-Chiari Syndrome in a Young Child: A Diagnostic Conundrum. Cureus 2021; 13:e16407. [PMID: 34414043 PMCID: PMC8364781 DOI: 10.7759/cureus.16407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 11/05/2022] Open
Abstract
Budd-Chiari syndrome (BCS) is an uncommon vascular disorder in which venous thrombosis prevents the venous outflow of the liver. The obstruction is primarily at the level of hepatic veins and inferior vena cava. Here, we present a case of a two-and-a-half-year-old male child who presented with complaints of abdominal distension for two months and fever and watery diarrhea for one month. Physical examination showed the patient was anemic with palmar erythema. He was started on an empirical treatment of cefotaxime, metronidazole, and amikacin. Sensitivity and culture reports for blood and urine samples were negative, but abdominal computed tomography (CT) scan showed characteristic findings for BCS with caudate lobe hypertrophy. After the symptomatic treatment of the patient, a liver transplant was suggested as a last resort.
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Affiliation(s)
- Yumna Timsaal
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Syed Hasan Ali
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Farheen Malik
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Ashok Chawla
- Pediatrics, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Karachi, PAK
| | - Jawad Ahmed
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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Sh Hassan AA, Alsaleh ME, Alsaleh ME, Al Zaher FA, Almajed FA, Alkhudhair AM, Alali MM, Alzayer HA, Alolayan AJ. Budd-Chiari Syndrome: A Case Report of a Rare Presentation of COVID-19. Cureus 2021; 13:e12554. [PMID: 33564546 PMCID: PMC7863030 DOI: 10.7759/cureus.12554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Coronavirus Disease 2019 (COVID-19) predominantly involves the respiratory system and shows a wide range of severity. There is a growing body of evidence about the occurrence of thromboembolic events in COVID-19. Case Report: We report the case of a 48-year-old female patient who presented with sudden-onset abdominal pain. Physical examination revealed ascites and tender hepatomegaly. Subsequently, abdominal computed tomography was performed which revealed thrombosis in the hepatic vein and inferior vena cava in keeping with Budd-Chiari Syndrome. The patient was started on low-molecular-weight heparin and supportive care. Clinical improvement was observed over the course of the treatment and the patient was discharged after 10 days from the presentation. Thromboembolic events could be the first manifestation of COVID-19. Early recognition of these complications is crucial for prompt management.
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Affiliation(s)
- Azhar A Sh Hassan
- Family and Community Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | | | | | | | | | | | - Maram M Alali
- Internal Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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Choudhry MS, Zaidi SMH, Mohiuddin O, Khan AA, Hanif A. Rare Association of Budd-Chiari Syndrome With Celiac Disease: A Case Report. Cureus 2020; 12:e11077. [PMID: 33224671 PMCID: PMC7678762 DOI: 10.7759/cureus.11077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Budd-Chiari associated with celiac disease is a rare phenomenon in the medical literature with annual incidence of less than five per million. The majority of the cases are reported from the North African region. Our patient presented in the out-patient department with symptoms of progressive abdominal distension, diffuse abdominal pain and shortness of breath for one year. She was a known case of celiac disease for the last three years. The clinical examination revealed ascites, jaundice, decreased air entry in basal segments bilaterally, and multiple hemangiomas all over the body. Haematological and biochemical investigations, including levels of pro-thrombotic factors and homocysteine level, turned out to be normal. However, computed tomography (CT) revealed hepatic vein obstruction. Hence, a diagnosis of Budd-Chiari syndrome was confirmed. The patient was managed with anticoagulants, diuretics and gluten-free diet. Within a month, the patient showed marked improvement with a significant reduction in ascites. To the best of our knowledge, this rare association is the first case to be reported from Pakistan and third from the region of South Asia.
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Affiliation(s)
- Muhammad Saad Choudhry
- General Surgery, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | | | - Osama Mohiuddin
- Internal Medicine, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | - Anosh Aslam Khan
- Internal Medicine, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | - Amber Hanif
- Internal Medicine, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
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13
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Lakshmanan S, Baskaran D, Onkarappa Mangala Y, Toubia N. Pseudocirrhosis in Chronic Budd Chiari Syndrome With Janus Tyrosine Kinase 2 (JAK2) Mutation. Cureus 2020; 12:e9355. [PMID: 32850227 PMCID: PMC7444998 DOI: 10.7759/cureus.9355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Budd-Chiari syndrome (BCS) occurs when there is hepatic venous outflow obstruction. Chronic BCS may result in liver cirrhosis due to long-standing obstruction and tend to present late. We present the first case of BCS secondary to Janus tyrosine kinase 2 (JAK2) mutation resulting in "pseudocirrhosis" rather than cirrhosis of the liver. Pseudocirrhosis clinically and radiologically mimics cirrhosis without the classical histopathological changes, and it is usually associated with metastatic cancers.
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Affiliation(s)
- Seetha Lakshmanan
- Internal Medicine, Roger Williams Medical Center, Boston University School of Medicine, Providence, USA
| | - Dhanya Baskaran
- Internal Medicine, Geriatric Research, Education and Clinical Center, Bruce W. Carter Veterans Affairs Medical Center, Miami, USA
| | | | - Nabil Toubia
- Gastroenterology, Roger Williams Medical Center, Providence, USA
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14
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Kim JH, Baek JH. Transient Budd-Chiari syndrome as an unpredictable complication of supradiaphragmatic inferior vena cava reconstruction after blunt thoracic trauma: A case report. Medicine (Baltimore) 2019; 98:e15821. [PMID: 31145318 PMCID: PMC6708969 DOI: 10.1097/md.0000000000015821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Supradiaphragmatic inferior vena cava (IVC) injury due to blunt thoracic trauma is extremely rare. Budd-Chiari syndrome (BCS) is also rare and presents with ascites, abdominal pain, hepatomegaly, leg swelling, and jaundice. Its etiology is diverse, and it is rarely caused by trauma. PATIENT CONCERNS A 36-year-old man with blunt trauma from a traffic accident presented with chest pain. Chest computed (CT) and emergency surgery with CPB revealed completely transected supradiaphragmatic inferior vena cava (IVC), which reconstruction was essential. DIAGNOSES BCS caused by impaired hepatic venous drainage through a reconstructed neo-IVC after severe blunt trauma injury to the supradiaphragmatic IVC was diagnosed. INTERVENTION Hepatic failure, ascites, leg swelling, and jaundice were resolved post-insertion of a veno-venous extracorporeal membrane oxygenator (V-V ECMO) for hepatic venous drainage, but these clinical symptoms reappeared after ECMO removal. OUTCOME The patient died from rapidly progressing sepsis, pneumonia, and acute renal failure during repeated insertion of ECMO and weaning off ECMO. LESSONS Reconstructing and improving the patency of the supradiaphragmatic IVC is essential for successful hepatic venous drainage. Additionally, a surgical strategy focused on graft selection can prevent kinking stenosis, and possibly BCS, especially in emergency surgeries. A ring-supported synthetic graft should be considered an alternative to improve long-term patency and survival rate.
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Affiliation(s)
- Jung Hee Kim
- Department of Thoracic and Cardiovascular Surgery, The Daegu Veterans Medical center
| | - Jong Hyun Baek
- Department of Thoracic & Cardiovascular Surgery, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Abstract
RATIONALE Diabetic foot ulcer is a severe complication of diabetes, and most patients with diabetic foot ulcer require amputation. The incidence of Budd-Chiari syndrome is low; it is relatively rare. Diabetic foot ulcer combined with Budd-Chiari syndrome has not been reported so far. PATIENT CONCERNS A 52-year-old man presented with uncontrolled high body temperature, continued expansion of the lower leg and foot ulcer with increasing malodor. DIAGNOSIS The patient was diagnosed with Wagner grade 4 diabetic foot ulcer combined with Budd-Chiari syndrome. INTERVENTIONS Critical treatment was performed immediately after his admission to the hospital. After the patient's condition was stable, we performed an interventional procedure to relieve the inferior vena cava obstruction. Debridement was then performed on the diabetic foot ulcer. Finally, skin grafting was performed due to condition of the wound. We completed moist healing and vacuum sealing drainage throughout the treatment process. OUTCOMES The patient was hospitalized for 56 days, and all his right lower extremity ulcers eventually healed. LESSONS In the treatment of diabetic foot ulcer combined with Budd-Chiari syndrome, it is necessary to develop a unified treatment plan that includes the timely treatment of Budd-Chiari syndrome upon admission, the strategic use of debridement, and the application of moist healing and vacuum sealing drainage.
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Affiliation(s)
- Lei Fan
- Department of Orthopedic Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Huan Luo
- Department of Ophthalmology, Campus Virchow, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Ophthalmology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University
| | - Bing Liu
- Department of Cardiovascular Surgery, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xianen Fa
- Department of Cardiovascular Surgery, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tao Liu
- Department of Orthopedic Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Chao Ma
- Department of Orthopedic Surgery, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
- Department of Cardiovascular Surgery, Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Department of Cardiology, Campus Virchow, Charité - Universitätsmedizin Berlin
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
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16
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Carvalho D, Oikawa F, Matsuda NM, Yamada AT. Budd-Chiari syndrome in association with Behçet's disease: review of the literature. SAO PAULO MED J 2011; 129:107-9. [PMID: 21603788 PMCID: PMC10896040 DOI: 10.1590/s1516-31802011000200009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 06/14/2010] [Accepted: 11/22/2010] [Indexed: 04/07/2023] Open
Abstract
The risk that patients with Behçet's disease may develop various thrombotic complications has been previously described. Although vascular complications from Budd-Chiari syndrome associated with Behçet's disease have been described, the pathogenic mechanisms are still unknown. Severe vascular complications present in Budd-Chiari syndrome associated with Behçet's disease are very common among young male adults. The objective of this study was to review the literature and present the association of Budd-Chiari syndrome with Behçet's disease.
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Affiliation(s)
- Daniela Carvalho
- MD. Resident Physician, Hospital Municipal de Campo Limpo "Dr. Fernando Mauro Pires da Rocha", São Paulo, SP, Brazil.
| | - Fernando Oikawa
- MD. Resident Physician, Hospital Municipal de Campo Limpo "Dr. Fernando Mauro Pires da Rocha", São Paulo, SP, Brazil.
| | - Nilce Mitiko Matsuda
- MD. Resident Physician, Hospital Municipal de Campo Limpo "Dr. Fernando Mauro Pires da Rocha", São Paulo, SP, Brazil.
| | - Alice Tatsuko Yamada
- MD, PhD. Research associate, Department of Surgery and Anatomy, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP, Brazil.
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17
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Peynircioglu B, Shorbagi AI, Balli O, Cil B, Balkanci F, Bayraktar Y. Is there an alternative to TIPS? Ultrasound-guided direct intrahepatic portosystemic shunt placement in Budd-Chiari syndrome. Saudi J Gastroenterol 2010; 16:315-8. [PMID: 20871209 PMCID: PMC2995113 DOI: 10.4103/1319-3767.70633] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Budd-Chiari syndrome is a spectrum of manifestations which develops as a result of hepatic venous outflow obstruction. Transjugular intrahepatic portosystemic shunt (TIPS) is a minimally invasive vascular and interventional radiological procedure indicated in the management of refractory ascites in such patients. Conventional TIPS requires the presence of a patent hepatic vein and reasonable accessibility to the portal vein, and in patients with totally occluded hepatic veins, this procedure is technically challenging. Direct intrahepatic portosystemic shunt (DIPS) or so called "percutaneous TIPS" involves ultrasound-guided percutaneous simultaneous puncture of the portal vein and inferior vena cava followed by introduction of a guidewire through the portal vein into the inferior vena cava, as a deviation from conventional TIPS. Described here is our experience with DIPS. Three patients with BCS who had refractory ascites but were unsuitable for conventional TIPS due to occlusion of the hepatic veins were chosen to undergo the DIPS procedure. Our technical success was 100%. The shunts placed in two patients remain patent to date, while the shunt in a third patient with underlying antiphospholipid syndrome was occluded a month after the procedure. The percutaneous TIPS procedure seems to be technically feasible and effective in the management of refractory ascites as a result of BCS, particularly in the setting of occluded hepatic veins.
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Affiliation(s)
- Bora Peynircioglu
- Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Ali Ibrahim Shorbagi
- Department of Gastroenterology, Hacettepe University, School of Medicine, Ankara, Turkey,Address for correspondence: Dr. Ali Shorbagi, Department of Gastroenterology, Hacettepe University, School of Medicine, Sihhiye, Ankara, Turkey 06100. E-mail:
| | - Omur Balli
- Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Barbaros Cil
- Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Ferhun Balkanci
- Department of Radiology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Yusuf Bayraktar
- Department of Gastroenterology, Hacettepe University, School of Medicine, Ankara, Turkey
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18
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Paradis V, Bièche I, Dargère D, Cazals-Hatem D, Laurendeau I, Saada V, Belghiti J, Bezeaud A, Vidaud M, Bedossa P, Valla DC. Quantitative gene expression in Budd-Chiari syndrome: a molecular approach to the pathogenesis of the disease. Gut 2005; 54:1776-81. [PMID: 16162682 PMCID: PMC1774794 DOI: 10.1136/gut.2005.065144] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Budd-Chiari syndrome (BCS) is associated with parenchymal changes leading to major architecture remodelling. In order to gain further insight into the pathogenesis of BCS, we investigated expression of a set of genes involved in the course of chronic liver diseases. METHODS Quantitative expression of 35 selected genes involved in extracellular matrix regulation, growth factors, and angiogenesis was investigated in 13 cases of BCS and compared with 10 normal livers and 13 cirrhosis cases by real time reverse transcription-polymerase chain reaction. Differential gene expression was considered significant for genes showing at least a twofold variation, with p < 0.05. RESULTS Expression of 14 genes was significantly increased in BCS versus normal liver, with the highest increase in superior cervical ganglion 10 (SCG10) gene. BCS cases were classified according to their evolution and morphological pattern as either acute or chronic in six and seven cases, respectively. Unsupervised hierarchical clustering of acute and chronic BCS cases on the basis of similarity in gene expression pattern led to distinction between the two groups. Expression of three genes was significantly different in acute versus chronic BCS (increase in matrix metalloproteinase 7 and SCG10, decrease in thrombospondin-1 for chronic BCS). Seventeen and 10 genes, mainly involved in extracellular matrix and vascular remodelling, were significantly deregulated in acute BCS versus normal liver and cirrhosis, respectively. CONCLUSION These results show that BCS cases display a specific gene expression profile that is different from that of normal liver and cirrhosis; the molecular configuration of BCS can be readily distinguished by its evolution and morphological pattern.
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Affiliation(s)
- V Paradis
- Service d'Anatomie Pathologique, Hôpital Beaujon, 110 bd du général Leclerc, 92118 Clichy Cedex, France.
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19
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Affiliation(s)
- R Sinha
- Department of Radiology, Glenfield Hospital, Leicester, UK.
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20
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Sebastian S, Tuite D, Crotty P, Torreggiani W, Buckley MJ. Painful ascites. Gut 2004; 53:1344, 1355. [PMID: 15306597 PMCID: PMC1774197 DOI: 10.1136/gut.2003.031609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- S Sebastian
- Department of Gastroenterology, Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland.
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Mancuso A, Watkinson A, Tibballs J, Patch D, Burroughs AK. Budd-Chiari syndrome with portal, splenic, and superior mesenteric vein thrombosis treated with TIPS: who dares wins. Gut 2003; 52:438. [PMID: 12584231 PMCID: PMC1773544 DOI: 10.1136/gut.52.3.438] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- A Mancuso
- Universita’ di Palermo, Scuola di Specializzazione in Gastroenterologia ed Endoscopia Digestiva, Reparto di Medicina, Ospedale V Cervello, Via Trabucco 180, 90144, Palermo, Italy
| | - A Watkinson
- Department of Radiology, Royal Free Hospital, London, UK
| | - J Tibballs
- Department of Radiology, Royal Free Hospital, London, UK
| | - D Patch
- Liver Transplantation Unit and Hepatobiliary Medicine, Royal Free Hospital, London, UK;
| | - A K Burroughs
- Liver Transplantation Unit and Hepatobiliary Medicine, Royal Free Hospital, London, UK;
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22
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Abstract
A 76-year-old woman with intravenous leiomyomatosis complicated by Budd-Chiari syndrome is described.
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Affiliation(s)
- B C Kuenen
- Department of Internal Medicine, St Antonius Ziekenhuis, Nieuwegein The Netherlands
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23
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Abstract
Antiphospholipid syndrome is characterized by recurrent episodes of arterial and venous thrombosis, spontaneous fetal losses, thrombocytopenia and persistently elevated levels of antiphospholipid antibodies. We experienced a case of Budd-Chiari syndrome in a 32-year old female lupus patient who was presented with left leg edema, ascites and esophageal varix. The clinical and laboratory findings were compatible with the cirteria for systemic lupus erythematosus (SLE) and she was found to have anticardiolipin antibody, thrombocytopenia and prolonged partial thromboplastin time. Initially, she was treated with intravenous heparin and uroki nase and she was followed up with warfarin, baby aspirin and steroids.
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Affiliation(s)
- Y Y Yun
- Department of Internal Medicine, Catholic University Medical College, Seoul, Korea
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