[Oral contraceptives and blood diseases are the most common causes of Budd-Chiari syndrome].
Two cases of young patients with the chronic form of Budd-Chiari syndrome are reported. The first concerns a 22-year-old woman with a 6-month history of hepatomegaly, who had used oral contraceptives almost continuously during the five years preceding diagnosis. In a thorough diagnostic work-up, thromboses were detected in all but one of the hepatic veins, and a possible non-occluding thrombosis in the retrohepatic portion of the inferior vena cava. In the blood and bone marrow, findings were compatible with polycythaemia rubra vera, and a high anti-cardiolipin antibody titre was found. The second case concerns a 25-year-old male smoker with normal bone marrow, who had thromboses in at least two of the hepatic veins, though the inferior vena cava was not occluded. In both cases a mesocaval shunt was interposed with synthetic grafts, and postoperatively the patients are doing well--at sixteen and five months, respectively. Both are maintained on anticoagulants, and even without diuretics there has been no recurrence of ascites. The woman takes a small dose of hydroxy-urea to control her hypercoagulability. To our knowledge, hers is the first case to be reported of Budd-Chiari syndrome with hypercoagulability due to the concomitant presence of oral contraceptives, polycythaemia rubra vera and anti-phospholipid antibodies.
Almer
S
S
Bodemar
G
G
Rydén
B O
BO
Elfström
J
J
Franzén
L
L
Ihse
I
I
Resjö
M
M
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001166:Arteriovenous Shunt, Surgical; D006502:Budd-Chiari Syndrome / Q000209:etiology* / Q000601:surgery; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects*; D004997:Ethinyl Estradiol / Q000009:adverse effects; D005260:Female; D006801:Humans; D016912:Levonorgestrel; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D009644:Norgestrel / Q000009:adverse effects; D011087:Polycythemia Vera / Q000150:complications*; D011859:Radiography
D000925:Anticoagulants; D003277:Contraceptives, Oral, Combined; D009644:Norgestrel; D004997:Ethinyl Estradiol; D016912:Levonorgestrel
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