Acute onset may lead to liver failure and death. More commonly, Budd-Chiari syndrome evolves over months into a chronic stage with vague abdominal pain and features of portal hypertension with splenomegaly and cirrhosis. The caudate lobe often becomes palpable as an epigastric mass. Diagnosis Biochemical abnormalities are not distinctive. Hepatic scintiscanning reveals increased uptake by the caudate lobe.
Hepatic venography defines the extent of thrombosis and any vena caval involvement.
Liver biopsy identifies the congestion and disappearance of hepatocytes in zone 3. Ultrasound shows hepatic vein abnormalities and caudate lobe enlargement. Doppler ultrasound detects altered blood flow. MRI reveals absent hepatic venous drainage and any abnormalities in the inferior vena cava or portal vein. Conservative management using thrombolysis is reserved for patients with incomplete obstruction of the hepatic veins or if clinical improvement is rapid.