What are the possible complications of Budd-Chiari syndrome?

Updated: Oct 10, 2018
  • Author: Praveen K Roy, MD, AGAF; Chief Editor: BS Anand, MD  more...
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Morbidity and mortality in Budd-Chiari syndrome are generally related to complications of liver failure and ascites but can also be impacted by the type of concomitant underlying disease, if any. Complications associated with Budd-Chiari syndrome include the following:

  • Hepatic encephalopathy

  • Variceal hemorrhage

  • Hepatorenal syndrome

  • Portal hypertension

  • Complications secondary to hypercoagulable state

  • Complications secondary to hepatic decompensation

Bacterial peritonitis is always of concern in the patient with ascites, especially if paracentesis is undertaken. Complications must also be considered in relation to therapies used (eg, thrombolytics). The mortality rate can be high in patients who develop fulminant hepatic failure.

Budd-Chiari syndrome can also lead to HCC (or oppositely, in some cases, develop secondary to it). In a retrospective study, Liu et al found evidence that HCC in primary Budd-Chiari syndrome is associated with blockage of the inferior vena cava and stricture of the hepatic venous outflow tract. The investigators’ results also indicated that transcatheter arterial chemoembolization (TACE) is an effective treatment for HCC in these patients, with a significant drop in alpha-fetoprotein levels after TACE treatment. The study included 246 patients with Budd-Chiari syndrome, including 14 with HCC. Ultrasonography, computed tomography (CT) scanning, magnetic resonance imaging (MRI), and angiography were used to determine the imaging characteristics in patients with HCC. [17]

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