Budd-Chiari syndrome: Radiologic findings

KEY CONCEPTS: 1. Diagnosis of Budd-Chiari syndrome can be made on the basis of radiological imaging alone without the need for liver biopsy. 2. Ultrasonography, computed tomography, and magnetic resonance imaging all show various degrees of occlusion of the hepatic veins and/or inferior vena cava. Hypertrophy of the caudate lobe may also be seen. 3. Computed tomographic and magnetic resonance imaging give a better idea of hepatic perfusion. Image reconstruction of the inferior vena cava is also possible. 4. Hepatic venography demonstrates a spiderweb pattern diagnostic of Budd-Chiari syndrome. 5. Pressure measurements in the portal vein and infrahepatic inferior vena cava are necessary to determine whether a surgical portosystemic shunt will be successful. 6. Transjugular intrahepatic portosystemic shunt provides definitive treatment in many patients; this is not discussed.