Budd-Chiari syndrome differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mazia Fatima, MBBS [2] Amandeep Singh M.D.[3]


Differential diagnosis

Budd-Chiari syndrome should be differentiated from other causes of hepatic failure like viral hepatitis and liver cirrhosis, splenic vein thrombosis, portal vein thrombosis and inferior vena cava obstruction that may have similar presentation with right upper quadrant abdominal pain and ascites. The differential diagnosis is as follows:

Condition Differentiating signs and symptoms Differentiating Tests
Budd-Chiari Syndrome

Ultrasound findings in cirrhosis are as follows:[1][2][3][4][5][6][7][8]

Abdominal MRI may also be helpful in the diagnosis of portal hypertension. Findings on MRI suggestive of cirrhosis with portal hypertension include:[9][10][11][12]

Transient elastography and the Acoustic Radiation Force Impulse (ARFI) technique are well-established methods for the staging of fibrosis in various liver diseases: [13][14][15][16][17][18][19][20][21][22][23] 

  • The FibroScan (transient elastography) uses elastic waves to determine liver stiffness which theoretically may be converted into a liver score.
  • The FibroScan produces an ultrasound image of the liver (from 20-80mm) along with a pressure reading (in kPa).
  • Transient elastography is much faster than a biopsy (usually lasts 2.5-5 minutes) and is completely painless.
  • Findings on transient elastography may show reasonable correlation with the severity of cirrhosis:[24][25]
Splenic vein thrombosis Signs and symptoms of:
Portal vein thrombosis
Inferior vena cava obstruction
Nodular regenerative hyperplasia None
Idiopathic portal hypertension (hepatoportal sclerosis) None


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