Ultrasonography in patients with Budd-Chiari syndrome: diagnostic signs and prognostic implications.
OBJECTIVE
We analyzed sonomorphological signs of Budd-Chiari syndrome (BCS) and their potential for prognosis prediction.


METHODS
Forty-five consecutive patients were included. Analysis included the frequencies of sonomorphological signs and their predictive value for diagnosis of BCS, mean values of laboratory and color Doppler data in different therapeutic groups and survival.


RESULTS
Specific ultrasound signs were identified at the level of the hepatic veins in 71% of the patients and in 33% at the level of the caval vein, i.e. thrombosis, stenosis, fibrotic cord or insufficient recanalization of the vessels. The frequent non-specific signs were splenomegaly (78%), inhomogeneous liver parenchyma (76%), intrahepatic collaterals (73%), caudate lobe hypertrophy (67%), ascites (56%) and extrahepatic collaterals (44%). The combination of specific signs and "caudate lobe hypertrophy" offered the highest predictive value to identify patients with BCS (p=0.014) with a specificity of 100%. Mean survival was significantly different between the patients with or without portal hypertension (n=25, 41.1+/-7.6, 95% CI (26.2-55.9) versus n=20, 89.4+/-4.5, 95% CI (80.5-98.2), p=0.004) and with or without portal vein thrombosis (n=12, 29.8+/-10.7, 95% CI (8.9-50.7) versus n=33, 79.3+/-6.1, 95% CI (67.4-91.1), p=0.003).


CONCLUSIONS
We present a comprehensive description of sonomorphological signs in BCS. The combination of ultrasound signs "altered hepatic and/or caval veins" and "caudate lobe hypertrophy" was the best strategy to diagnose BCS. Patients with portal vein thrombosis or portal hypertension have a poor prognosis.
Boozari
Bita
B
Medical School of Hannover, Department of Gastroenterology, Hepatology and Endocrinology, Hannover, Germany. bita.boozari@t-online.de
Bahr
Matthias J
MJ
Kubicka
Stefan
S
Klempnauer
Juergen
J
Manns
Michael P
MP
Gebel
Michael
M
D000328:Adult; D000368:Aged; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D006984:Hypertrophy; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012039:Regional Blood Flow / Q000502:physiology; D012044:Regression Analysis; D012189:Retrospective Studies; D014463:Ultrasonography