ULTRASOUND AND MR FINDINGS IN ACUTE BUDD-CHIARI SYNDROME WITH HISTOPATHOLOGIC CORRELATION

This report describes the sonographic and MR appearances of acute Budd -Chiari syndrome (BCS) in a 30-year-old woman. Current imaging techniq ues including duplex Doppler sonography and dynamic gadolinium-enhance d MRI were employed, and direct histopathologic correlation was made. Duplex Doppler sonography revealed a heterogeneous enlarged liver, no flow in the left and middle hepatic veins, and only trace abnormal flo w in the distal-most right hepatic vein. Dynamic serial gadolinium-enh anced, spoiled gradient echo imaging demonstrated early homogeneous en hancement of an enlarged caudate lobe, as well as heterogeneously decr eased enhancement of the remainder of the hepatic parenchyma. This dif ferential enhancement pattern persisted on delayed imaging. Patent hep atic veins were not demonstrated on any sequence. Associated findings included hepatomegaly, ascites, and patent portal vasculature. These i maging findings were interpreted as consistent with acute BCS. Within 10 days, the patient underwent orthotopic liver transplantation. Histo pathology demonstrated hepatic necrosis and hepatic venous thrombosis consistent with acute BCS.