Ultrasound characteristics of Budd-Chiari syndrome: a multicenter analysis
Introduction: Budd-Chiari syndrome (BCS) is a rare liver disease defined as an obstruction of the hepatic venous outflow, potentially leading to severe complications like liver failure. BCS can be classified as primary (due to endoluminal venous lesions such as thrombosis) or secondary (due to exter...
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| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
April 2026
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| In: |
Digestive diseases
Year: 2026, Volume: 44, Issue: 2, Pages: 192-205 |
| ISSN: | 1421-9875 |
| DOI: | 10.1159/000549007 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.1159/000549007
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| Author Notes: | Jimmy Daza, Isabella Wiest, Xin Wu Cui, Bo Zhang, Yunhao Chen, Yi Dong, Chiara De Molo, Carla Serra, Nitin Chaubal, Ehsan Safai Zadeh, Christian Görg, Theresa Tscheu, Matthias P. Ebert, Andreas Teufel, Christoph F. Dietrich |
| Summary: | Introduction: Budd-Chiari syndrome (BCS) is a rare liver disease defined as an obstruction of the hepatic venous outflow, potentially leading to severe complications like liver failure. BCS can be classified as primary (due to endoluminal venous lesions such as thrombosis) or secondary (due to external compression or invasion of the hepatic veins or inferior vena cava; IVC). While numerous case reports illustrate imaging findings in individual patients, systematic data processing across multiple regions is lacking and establishing consistent ultrasound diagnostic criteria could significantly improve early detection and patient outcomes. Methods: This retrospective multicenter study (2010-2020) included 118 patients from China (n = 59), Germany (n = 26), India (n = 18), and Italy (n = 15). The study used standardized ultrasound protocols, including Doppler and contrast-enhanced ultrasound, to assess hepatic venous outflow and other key findings, such as the presence of hepatic-vein thrombosis, caudate lobe hypertrophy, and collateral circulation. Results: The cohort comprised 118 patients (65 men, 53 women; mean age 46 years). Most cases had a chronic disease course (74%), and primary BCS (n = 96, 81%), related to thrombotic alterations, predominated over secondary BCS, related to compressive masses (n = 7, 6%). Key sonographic features observed included portal vein thrombosis (14%), hepatic-vein thrombosis (70%), caudate lobe enlargement (30%), and collateral venous circulation (83%). Among the geographical differences in symptoms, thrombosis of the IVC was common in Chinese patients (33%), while the confluence area and hepatic veins were more frequently involved in European patients. Conclusions: This study provides the first multicenter analysis of ultrasound characteristics in BCS patients from multiple regions. The findings support ultrasound as an essential tool in the standardized diagnostic process for BCS, particularly for identifying key sonographic features such as hepatic-vein thrombosis and caudate lobe enlargement. These results underscore the importance of standardized ultrasound protocols in BCS to facilitate early diagnosis and improve patient outcomes. Budd-Chiari syndrome (BCS) is an uncommon disease in which the veins that carry blood out of the liver become blocked. When blood cannot leave the liver, the organ can swell and may fail. Ultrasound, a painless scan that uses sound waves, is often the first test doctors use to look for this blockage. We studied ultrasound records from 118 adults with BCS treated in China, Germany, India, and Italy between 2010 and 2020. Every hospital followed the same scanning steps, including Doppler and contrast-enhanced ultrasound (methods that show blood flow and highlight vessels with a harmless dye). We recorded which liver veins were closed and what other changes had taken place inside the liver. Most people (81%) had a clot, or thickened blood, inside the liver veins; only a few had blockage caused by a nearby tumor or other mass. The scans showed new “detour” veins in 83% of patients, indicating that the body had tried to bypass the blockage. About one-third had an enlarged section of the liver called the caudate lobe. Blockage of the large vein below the heart, the inferior vena cava, was more frequent in the Chinese group, while blockages nearer to where the liver veins join this large vein were more common in the European groups. Using the same ultrasound checklist in several countries confirmed a clear set of ultrasound signs that can help doctors identify BCS earlier and choose timely treatment. |
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| Item Description: | Online veröffentlicht: 23. Februar 2026 Gesehen am 15.06.2026 |
| Physical Description: | Online Resource |
| ISSN: | 1421-9875 |
| DOI: | 10.1159/000549007 |