Abstract
Article: Sonographic Evaluation of Budd-Chiari Syndrome With Intracaval Stent
Author: Rochelle King
Category: Vascular
Credit: 1.0 SDMS CME Credit
Objectives: After studying the article titled “Sonographic Evaluation of Budd-Chiari Syndrome With Intracaval Stent,” you will be able to:
describe the pathophysiology of Budd-Chiari syndrome
use appropriate sonographic techniques to diagnose Budd-Chiari syndrome
determine the hemodynamic characteristics of an intracaval stent
Duplex ultrasonography for Budd-Chiari syndrome has been reported to have a sensitivity of approximately 75% to 80% 80% to 85% 85% to 90% 90% to 95%
The hemodynamics of Budd-Chiari syndrome are primarily characterized by increased hepatopetal flow hepatic venous flow obstruction increased inferior vena cava pulsatility increased hepatic arterial inflow
The first stage of treatment for Budd-Chiari syndrome is typically porto-systemic shunting with a TIPS procedure anticoagulation angioplasty with possible stenting of short segment hepatic vein thromboses liver transplantation
In the Western Hemisphere, Budd-Chiari syndrome is seen more commonly in females in the third or fourth decade of life males in the third or fourth decade of life females in the fifth or sixth decade of life males in the fifth or sixth decade of life
In the chronic phase of Budd-Chiari syndrome, the hepatic veins are hyperechoic and enlarged hypoechoic and enlarged hyperechoic with thickened walls often not visualized
Sonographic features of the acute phase of Budd-Chiari syndrome include a shrunken, nodular hyperechoic liver with possible hepatic vein enlargement a shrunken hypoechoic liver with possible hepatic vein enlargement a large, bulbous hypoechoic liver with possible hepatic vein enlargement a large, bulbous hyperechoic liver with possible hepatic vein enlargement
Hemodynamic changes in hepatic venous blood flow in cases of Budd-Chiari syndrome typically include diminished flow with loss of phasicity diminished flow with increased phasicity increased flow with loss of phasicity increased flow with increased phasicity
The patient position most likely to lead to poor Doppler angles and artifacts when evaluating the inferior vena cava is left lateral decubitus left posterior oblique supine right posterior oblique
Normal hepatic veins have a diameter of 4 to 7 mm with predominantly antegrade flow and significant heart rate pulsatility a diameter of 2.5 to 3.5 cm with predominantly antegrade flow and significant heart rate pulsatility a diameter of 4 to 7 mm with little net flow and little heart rate pulsatility a diameter of 2.5 to 3.5 cm with little net flow and little heart rate pulsatility
Additional sonographic features of chronic Budd-Chiari syndrome include all of the following except
liver contour irregularities hypertrophic caudate lobe of the liver regenerative liver nodules hypoechogenicity of the liver
Footnotes