Budd-Chiari syndrome CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mazia Fatima, MBBS [2]


CT scan may be helpful in the diagnosis of Budd-Chiari syndrome. Contrast-enhanced computed tomography (CT) is performed in portal venous phase, this helps to obtain good contrast filling in the portal, mesenteric, and hepatic veins and in inferior vena cava for detection of associated pathology. Findings on CT scan suggestive of Budd-Chiari syndrome include early enhancement of the caudate lobe and central liver around the inferior vena cava, delayed enhancement of the peripheral liver with accompanying central low density (flip-flop appearance), inhomogeneous mottled liver (nutmeg liver), peripheral zones of the liver may appear hypo-attenuating because of reversed portal venous blood flow, inability to identify hepatic veins, in the chronic phase, there is caudate lobe enlargement and atrophy of the peripheral liver in affected areas.


Mottled peripheral hypodensity to the right liver. Appearances are of right liver hypoperfusion, probably from venous congestion from complete right and middle hepatic vein thrombosis. This represents Budd-Chiari syndrome.Case courtesy of Dr Henry Knipe, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. From the case <a href="https://radiopaedia.org/cases/27929">rID: 27929</a>


  1. Kim TK, Chung JW, Han JK, Kim AY, Park JH, Choi BI (1999). "Hepatic changes in benign obstruction of the hepatic inferior vena cava: CT findings". AJR Am J Roentgenol. 173 (5): 1235–42. doi:10.2214/ajr.173.5.10541095. PMID 10541095.
  2. Torabi M, Hosseinzadeh K, Federle MP (2008). "CT of nonneoplastic hepatic vascular and perfusion disorders". Radiographics. 28 (7): 1967–82. doi:10.1148/rg.287085067. PMID 19001652.
  3. Grus T, Lambert L, Grusová G, Banerjee R, Burgetová A (2017). "Budd-Chiari Syndrome". Prague Med Rep. 118 (2–3): 69–80. doi:10.14712/23362936.2017.6. PMID 28922103.