Triphasic helical CT in Budd-Chiari syndrome: patterns of enhancement in acute, subacute and chronic disease.
OBJECTIVE
To retrospectively evaluate helical computed tomography (CT) findings in a series of consecutive patients with Budd-Chiari syndrome.


METHODS
Patterns of enhancement observed at contrast-enhanced helical CT in 10 consecutive patients (six women, four men; aged 27-51 years) with either acute, subacute or chronic Budd-Chiari syndrome were retrospectively evaluated along with the status of the hepatic veins. All patients underwent triphasic helical CT (10 mm beam collimation, 7 mm rec. intervals, 120 kV, 200-250 mA, pitch = 1.0) performed at 20-25, 70-75 and 300 s after i.v. bolus (3 ml/s) injection of 150 ml iodinated non-ionic contrast media.


RESULTS
Abnormal patterns of enhancement were identified in eight patients. In all patients with acute Budd-Chiari disease (3/3) abnormal arterial enhancement of the caudate lobe, the so-called "fan-shaped pattern" was observed, whereas visible venous thrombosis was only depicted in two. Conversely, a "patchy pattern" of enhancement was observed in five out of seven patients with either sub-acute (2) or chronic Budd-Chiari disease (5) along with a strip-like appearance or lack of visualization of hepatic veins.


CONCLUSIONS
The "fan-shaped" pattern of enhancement represent a characteristic finding of acute Budd-Chiari disease, and it may help to suggest the correct diagnosis even in absence of visible venous thrombosis.
Department of Radiology, University Federico II, Naples, Italy. camera@unina.it
L
L
Camera
P P
PP
Mainenti
A
A
Di Giacomo
M
M
Romano
A
A
Rispo
F
F
Alfinito
M
M
Imbriaco
E
E
Soscia
M
M
Salvatore
D000208:Acute Disease; D000368:Aged; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging*; D002908:Chronic Disease; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed / Q000379:methods; D020246:Venous Thrombosis / Q000000981:diagnostic imaging