title: CT, MRI, and US findings of incidental segmental distal hepatic vein occlusion: a new form of Budd-Chiari syndrome?
abstract: OBJECTIVE
  We aimed to describe radiological findings of patients with incidentally diagnosed segmental distal hepatic vein occlusion on computed tomography (CT), ultrasonography (US), and magnetic resonance imaging (MRI).
  
  
  METHODS
  We retrospectively reviewed CT (n = 8), color Doppler US (n = 6), and MRI (n = 3) findings of 9 patients with incidentally diagnosed segmental occlusion of the hepatic veins from our archive. Computed tomography and US examinations were performed in 4 patients; only CT in 2; US, CT, and MRI in 1; US and MRI in 1; and CT and MRI in 1 patient. Liver contour, presence, and location of hepatico-hepatic shunts were evaluated.
  
  
  RESULTS
  Middle hepatic vein (n = 6) was the most commonly segmentally occluded vein, followed by left hepatic vein (n = 3). Mean length of segmental occlusion was 1.9 cm (range, 1.2-4.2 cm). Hepatico-hepatic shunts were found close to hepatic vein confluence in all but 1 patient. Segmental distal hepatic vein occlusion can cause antegrade (n = 5) or retrograde (n = 1) flow in the affected vein on color Doppler examination, depending on presence of intraparenchymal hepatico-hepatic shunt. In the patient with retrograde flow, occluded segment was very short, and no intraparenchymal shunt was visible. Patients were asymptomatic, and no change in liver morphology (including caudate lobe hypertrophy) was noted.
  
  
  CONCLUSIONS
  We propose that segmental Budd-Chiari syndrome can be a valid terminology for asymptomatic patients with segmental hepatic vein occlusion most likely developing as a sequela of subclinical Budd-Chiari syndrome. Acquaintance of practicing radiologists to this phenomenon may be highly useful in the prevention of the diagnostic confusion and potentially unnecessary interventions.
authors.affiliation: Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Devrim
authors.initials: D
authors.lastname: Karaosmanoglu
authors.forename: Musturay
authors.initials: M
authors.lastname: Karcaaltincaba
authors.forename: Deniz
authors.initials: D
authors.lastname: Akata
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ozmen
authors.forename: Okan
authors.initials: O
authors.lastname: Akhan
mesh_terms: D000328:Adult; D000368:Aged; D006502:Budd-Chiari Syndrome / Q000175:diagnosis*; D005260:Female; D006503:Hepatic Veins / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D033162:Incidental Findings; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D009626:Terminology as Topic; D014057:Tomography, X-Ray Computed / Q000379:methods*; D018615:Ultrasonography, Doppler, Color / Q000379:methods*