Budd Chiari

Budd Chiari syndrome is a rare problem that results from blood clotting in the veins flowing out of the liver (hepatic veins). The high pressure of blood in these veins leads to an enlarged liver, and to an accumulation of fluid in the abdomen, called ascites.                

Hepatic vein obstruction

The liver, the largest internal organ in the human body, is responsible for many vital physiologic processes. Blood flow through the liver nourishes the liver, carries in substances that the liver will process, and carries away substances that the liver has produced. When blood cannot flow out freely from the liver, blood pressure rises in the veins of the liver, leading to blood clots within the liver. Also, some of the blood plasma can leak through the walls of the veins and accumulate within the abdomen (ascites).


Hepatic vein obstruction prevents blood from flowing out of the liver and back to the heart. This blockage can cause liver damage. Obstruction of this vein can be caused by masses pressing on the vessel (tumor) or by thrombus (clot) formation within the vessel.
Most often, it is caused by conditions that increase the body's propensity to form blood clots. These include:

  • Any of a number of hereditary or acquired clotting abnormalities

  • Myeloproliferative disorders abnormal proliferation of cells from the bone marrow

  • Chronic inflammatory or autoimmune diseases

  • Cancers

  • Oral contraceptives and pregnancy

  • Infections


  • Right-sided abdominal pain and a large liver

  • Jaundice (yellowing of the skin)

  • Ascites (swelling of the abdomen due to the development of fluid in the abdomen)

  • Vomiting blood

Signs and Tests

  • Elevated results of liver function tests

  • Ultrasound of the liver

  • CT scan or MRI of the abdomen

  • Liver biopsy


Diagnosis of Budd-Chiari syndrome can be made by an internist (a specialist in diseases of the internal organs), a gastroenterologist (a specialist in the diseases of the digestive system), or a general surgeon. On physical examination, the doctor will note that the liver is larger than normal. Often an ultrasound scan of the liver will show abnormalities in the size of the liver, an abnormal pattern of the veins in the liver, and other abnormalities. A CT scan will often show similar abnormalities.

Once these abnormalities are confirmed, the key test is called hepatic vein catheterization. In this test, a narrow tube is snaked through the body until it reaches the hepatic veins. An instrument at the tip of the catheter can measure the pressure within each segment of the hepatic vein. 

In some cases, a tiny amount of radioactive material is injected into a patient, and then an abnormal pattern of radioactivity in the liver can be revealed. In other cases, a liver biopsy enables a physician to examine cells from the liver itself. Cells damaged by Budd-Chiari syndrome have a characteristic appearance easily identifiable to a physician.


The best approach to prevention is to carefully control the blood disorders that can lead to Budd-Chiari syndrome.


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