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Systemic thrombolysis for acute, severe Budd-Chiari syndrome

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Abstract

Budd-Chiari syndrome (BCS) or hepatic venous outflow obstruction, is a rare and complex clinical entity, with diverse aetiology and a wide range of presentations. Its rarity and heterogeneity create significant challenges for evidence-based clinical decision-making, particularly in the even more infrequent setting of acute BCS presentation. Here we present the case of a young woman with acute, severe BCS, where treatment alternatives were limited due to a significant IVC thrombus burden. A clearly defined acute onset allowed the prompt use of systemic thrombolysis, conducted in consultation with a multi-disciplinary team of clinicians, with close monitoring for both treatment response and complications. Her treatment resulted in resolution of hepatic vein occlusion and prevention of the potentially significant clinical sequelae. We review the literature and discuss current opinion in the management of BCS.

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Authors and Affiliations

  1. Duke Clinical Research Institute, Duke University, Durham, NC, 27715, USA

    Paul J. Clark

  2. Department of Gastroenterology, Princess Alexandra Hospital, Brisbane, Australia

    Paul J. Clark

  3. Chair of Medical Imaging, The Prince Charles Hospital, Brisbane, Australia

    Richard E. Slaughter

  4. Adult Congenital Heart Disease Unit, Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia

    Dorothy J. Radford

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  1. Paul J. Clark
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  2. Richard E. Slaughter
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  3. Dorothy J. Radford
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Correspondence to Paul J. Clark.

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Clark, P.J., Slaughter, R.E. & Radford, D.J. Systemic thrombolysis for acute, severe Budd-Chiari syndrome. J Thromb Thrombolysis 34, 410–415 (2012). https://doi.org/10.1007/s11239-012-0760-4

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