Hepatic venous outflow obstruction: Three similar syndromes

Table 2 Radiological findings, treatment, and prognosis in VOD, BCS, and CH

	VOD	BCS	CH
Radiological findings	Ultrasonography to rule out other liver disorders	Doppler: Abnormal flow in a hepatic vein; large intrahepatic collateral vessels; e nlarged, stenotic, or tortuous hepatic veins	Dilatation of all three hepatic veins on sonogram
	Doppler may show reverse blood flow in the portal vein	MRI: Large intrahepatic comma shaped c ollaterals. Hepatic venography: Spider web venous network pattern	ECHO: Increased pulmonary artery pressure, dilatation of right side of heart, TR, abnormal diastolic ventricular filling due to pericardial disease
Treatment	(1) Prevention: UDCA, heparin, LMWH, and defibrotide	(1) Prevention of thrombus extension: Anticoagulation with heparin and warfarin	Treatment of the underlying heart disease
	(2) Treatment: Symptomatic care, defibrotide, tPA, AT-III concentrate	(2) Restoration of blood flow: Thrombolytic therapy, percutaneous, angioplasty, TIPS, or shunt surgery	Pericardiectomy in constrictive pericarditis
	(3)TIPS and liver transplantation in selected cases	(3) Liver transplantation
Prognosis	Mortality rate between 9% to 98% depending on the severity	Five-year survival rate 42% to 89% in hepatic vein thrombosis and 25% in IVC obstruction	Liver disease rarely contributes to mortality in these patients

MRI: Magnetic resonance imaging, TR: Tricuspid regurgitation, ECHO: Transthoracic echocardiogram UDCA: Ursodeoxycholic acid, LMWH: Low-molecular weight heparin, tPA: Tissue plasminogen activator, AT-III: Anti-thrombin III, TIPS: Transjugular intrahepatic portosystemic shunt.