What is Budd-Chiari Syndrome?

• A. A condition in which the hepatic veins are blocked or narrowed by a clot. Patients may present with decreased, absent, or reversed flow in hepatic veins, thrombosis of hepatic veins, and/or narrowing of IVC
• B. A disease of gallbladder inflammation
• C. A hepatic artery occlusion
• D. A venous obstruction of the portal vein

Answer: (A)

Budd-Chiari Syndrome is hepatic venous outflow obstruction. It happens when the hepatic veins (or the suprahepatic IVC) become blocked, most often by a blood clot, so the liver cannot drain properly. This impairs drainage, leading to congestion of the liver and can cause symptoms like abdominal pain, enlarged liver, and ascites. On imaging and Doppler studies, you’d expect to see decreased, absent, or even reversed flow in the hepatic veins, along with evidence of hepatic vein thrombosis and sometimes narrowing of the IVC near the liver. That description precisely matches Budd-Chiari.

It’s not a gallbladder inflammation, so those signs point away from cholecystitis. It isn’t hepatic artery occlusion, which would affect arterial blood supply rather than venous drainage. And it isn’t a portal vein problem, which would primarily involve portal hypertension from portal venous outflow obstruction rather than hepatic venous outflow.