Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2021; 9(12): 2937-2943
Published online Apr 26, 2021. doi: 10.12998/wjcc.v9.i12.2937
Budd-Chiari syndrome associated with liver cirrhosis: A case report
Qiao-Bo Ye, Qin-Feng Huang, Yao-Chang Luo, Yi-Lei Wen, Zi-Kun Chen, Ai-Ling Wei
Qiao-Bo Ye, Basic Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, Sichuan Province, China
Qin-Feng Huang, Department of Oncology, The First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi Zhuang Autonomous Region, China
Yao-Chang Luo, Department of Intervention, The First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi Zhuang Autonomous Region, China
Yi-Lei Wen, Department of Pathology, The First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi Zhuang Autonomous Region, China
Zi-Kun Chen, Graduate School, Guangxi University of Chinese Medicine, Nanning 530200, Guangxi Zhuang Autonomous Region, China
Ai-Ling Wei, Department of Liver Disease, The First Affiliated Hospital, Guangxi University of Chinese Medicine, Nanning 530023, Guangxi Zhuang Autonomous Region, China
Author contributions: Wei AL conceived and designed the study; Ye QB and Huang QF acquired the data, drafted and edited the manuscript; Luo YC and Wen YL provided technical and material support; Chen ZK analyzed and interpreted the data; all authors read and approved the final version of the manuscript.
Supported by National Natural Science Foundation of China, No. 81760851; and Doctoral Research Start-up Fund of Guangxi University of Chinese Medicine, No. 2019BS035.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ai-Ling Wei, MD, Chief Physician, Dean, Professor, Department of Liver Disease, The First Affiliated Hospital, Guangxi University of Chinese Medicine, No. 89-9 Dongge Road, Nanning 530023, Guangxi Zhuang Autonomous Region, China. weial@gxtcmu.edu.cn
Received: December 31, 2020
Peer-review started: December 31, 2020
First decision: January 17, 2021
Revised: January 27, 2021
Accepted: February 8, 2021
Article in press: February 8, 2021
Published online: April 26, 2021
Processing time: 104 Days and 13.2 Hours
Abstract
BACKGROUND

Budd-Chiari syndrome (BCS) is a rare heterogeneous liver disease characterized by obstruction of the hepatic venous outflow tract. The incidence of BCS is so low that it is difficult to detect in general practice and difficult to include within the scope of routine diagnosis. The clinical manifestations of BCS are not specific; hence, BCS tends to be misdiagnosed.

CASE SUMMARY

We report the case of a 33-year-old Chinese woman who presented with progressive distension in the upper abdomen. She was initially misdiagnosed with liver cirrhosis (LC) due to abnormalities on an upper abdominal computed tomography scan. Although she was taking standard anti-cirrhosis therapy, her symptoms did not improve. Magnetic resonance imaging showed caudate lobe hypertrophy; and dilated lumbar and hemiazygos veins. Venography revealed membranous obstruction of the inferior vena cava owing to congenital vascular malformation. A definitive diagnosis of BCS was made. Balloon angioplasty was performed to recanalize the obstructed inferior vena cava and the patient’s symptoms were completely resolved.

CONCLUSION

BCS lacks specific clinical features and can eventually lead to LC. Clinicians and radiologists must carefully differentiate BCS from LC. Correct diagnosis and timely treatment are vital to the patient's health.

Keywords: Budd-Chiari syndrome; Liver cirrhosis; Venography; Balloon angioplasty; Inferior vena cava; Case report

Core Tip: Budd-Chiari syndrome (BCS) is a rare heterogeneous liver disease cha-racterized by obstruction of the hepatic venous outflow tract. We report a case of BCS initially misdiagnosed as liver cirrhosis due to the abnormalities visible on an upper abdominal computed tomography scan. Further examinations were performed to establish a diagnosis. Magnetic resonance imaging revealed a narrowed inferior vena cava. Liver biopsy and pathological analysis showed hepatocyte degeneration, bridging fibrosis, sinusoidal dilatation, and areas of fibrous tissue with substantial hyperplasia, suggesting that BCS was the cause of liver cirrhosis.