Subacute Budd-Chiari syndrome associated with polycythemia vera and factorV Leiden mutation

We describe a 48-year-old caucasian woman with a subacute Budd-Chiari syndr ome attributed to the presence of polycythaemia vera, heterozygosity for th e factor V Leiden mutation and the use of an oral contraceptive pill. Two d iagnostic pitfalls were encountered. First, on CT scanning of the abdomen t he still normally vascularized central part of the liver was initially judg ed as a hypervascular tumour. Second, there was difficulty to recognize the thrombocytosis/leukocytosis in relation with portal hypertension and hyper splenism. Our case illustrates the obstacles which can be faced during the diagnostical process in a subacute form of Budd-Chiari syndrome. Furthermor e, our case illustrates the need for routinely screening of the factor V Le iden mutation in patients with Budd-Chiari syndrome. (C) 2000 Elsevier Scie nce B.V. All rights reserved.