title: Intraoperative Transesophageal Echocardiographic Diagnosis of Acute Budd-Chiari Syndrome After Extended Right Hepatectomy.
abstract: Budd-Chiari syndrome (BCS) is a congestive hepatopathy caused by hepatic venous outflow obstruction. Torsion of the remnant liver after extended right hepatectomy is a potential cause of acute BCS, and it can lead to acute liver failure or death. We present a case of intraoperative transesophageal echocardiographic (TEE) diagnosis of acute BCS after extended right hepatectomy. TEE allowed timely detection of acute BCS and consequent inferior vena cava obstruction and decreased right atrial filling as the cause of sudden life-threatening hemodynamic collapse unresponsive to intravascular volume therapy and inotropic support. TEE constituted a stepped-up level of monitoring, prompting an immediate surgical reexploration, and resolution of hemodynamic instability.
authors.affiliation: From the Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Alcaraz
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Meineri
authors.forename: Kathleen
authors.initials: K
authors.lastname: Dattilo
authors.forename: Marcin
authors.initials: M
authors.lastname: Wąsowicz
mesh_terms: D000208:Acute Disease; D000328:Adult; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging* / Q000209:etiology; D017548:Echocardiography, Transesophageal / Q000379:methods*; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*