Aged Budd-Chiari syndrome attributed to chronic deep venous thrombosis with alcoholic liver cirrhosis

Budd-Chiari syndrome is a rare disease, but there are many known causes. Re cent studies showed that it can be an acquired lesion resulting from thromb osis in some elderly patients. We report a 74-year-old man with Budd-Chiari syndrome attributed to chronic deep venous thrombosis and alcoholic liver cirrhosis. When he was aged 45 years, stasis ulcers of the lower extremitie s appeared. Cerebral infarction and left hemiparesis occurred at age 71. Ul trasonography, venacavography, and three-dimensional-magnetic resonance ima ging on admission demonstrated total obstruction of the inferior vena cava with several massive thrombi and developed collateral vessels. Although the etiology of the thrombosis remained obscure, we made some speculative assu mptions that chronic disseminated intravascular coagulation (which is frequ ently observed in cirrhosis) or hereditary coagulopathy could be involved, from his familial history of thrombotic phenomena and a severe deficiency o f clotting inhibitors. Despite the high mortality of untreated Budd-Chiari syndrome reported in previous studies, this patient had been alive for abou t 30 years from the suspected onset.