Chronic GVHD may involve the skin, liver, esophagus, and lungs. Imaging in GVHD is relevant only in the most severe cases and usually is limited to the small bowel. In the most severe cases, diffuse narrowing of the intestine, with a featureless ribbon-like appearance, may occur. It has been suggested that prolonged barium coating of the bowel may be suggestive of GVHD, reflecting formation of pseudomembranes and the trapping of barium on the mucosa. Toxicity to the liver results in hepatic edema, venous compression, and stagnation, and finally occlusion of hepatic veins.
Venous occlusion leads to further hepatic edema and dysfunction.
Symptoms include abdominal tenderness, hepatomegaly, jaundice, edema, and ascites. Most HVOD is mild and reversible, but severe cases may be fatal. The small veins are occluded with HVOD, while larger veins become involved only late in the course of the disorder. Imaging of the liver in HVOD with duplex color Doppler sonography may show heterogeneous echogenicity of the liver, ascites, hepatomegaly, and thickening of the gallbladder wall. 9,10 Diminished flow in the hepatic veins or reversed flow in the portal vein may occur.