Which Doppler finding may be seen in Budd-Chiari?

• A. Decreased, absent, or reversed flow in hepatic veins
• B. Increased hepatic arterial flow
• C. Normal hepatic vein flow
• D. Increased portal vein velocity only

Answer: (A)

Budd-Chiari syndrome obstructs hepatic venous drainage, so Doppler ultrasound most characteristically shows abnormal hepatic vein flow. The obstruction causes venous congestion with reduced, absent, or even reversed flow in the hepatic veins. This reflects the inability of blood to exit the liver through the hepatic veins, leading to upstream pressure and engorgement. While a compensatory increase in hepatic artery flow can occur in response to altered hepatic perfusion, it is not the defining finding. Normal hepatic vein flow would argue against Budd-Chiari, and changes limited to the portal vein without hepatic vein flow disruption do not capture the primary issue.