E5319. Diagnostic and Interventional Radiology for Budd-Chiari: An Update on BCS Classification and IVUS
Authors
Anne Sailer;
Yale School of Medicine
Margarita Revzin;
Yale School of Medicine
Meghan Lubner;
University of Wisconsin
Rachita Khot;
University of Virginia
Nariman Nezami;
University of Maryland Medical Center
Angelo Marino;
Yale School of Medicine
Todd Schlachter;
Yale School of Medicine
Background
Budd-Chiari syndrome (BCS) is the occlusion of one or more veins of the liver due to various disorders that result in sinusoidal congestion, portal hypertension, fibrosis, cirrhosis, and nodular regeneration. The new BCS classifications can provide more appropriate treatment options, accurately determining the type of obstructor, number of blocked vessels, and length of the obstruction. Categorizing the patients according to the updated BCS classification can improve the success of the patient’s therapeutic treatment plan.
Educational Goals / Teaching Points
1. Review pathophysiology of Budd Chiari and the BCS classifications. Briefly review potential mimics of Budd Chiari (i.e., other cause of sinusoidal or post hepatic obstruction). Discuss general concepts of assessing the liver Doppler US, CTA, MRA, venography, and intravascular ultrasound (IVUS) with emphasis on technique, protocol, and image optimization for diagnosing Budd Chiari. Describe differentiating imaging features of various BCS presentations depending on the location of the occlusion. Review complications associated with BCS. Briefly demonstrate pitfalls of BCS. Discuss management options with interventional radiology procedures (venoplasty and stenting, local pharmacologic and mechanical thrombolysis, TIPS placement), and potential complications.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Pathogenesis of Budd Chiari and the different types of portal HTN. Discuss general concepts of assessing the liver Doppler US, CTA, MRA, venography, and IVUS with emphasis on technique, protocol, and image optimization for diagnosing Budd Chiari. Discuss management options with interventional radiology procedures (venoplasty and stenting, local pharmacologic and mechanical thrombolysis, TIPS placement), and potential complications.
Conclusion
Budd Chiari is a complex multifaceted disorder. Understanding the classification, imaging findings, and treatment strategies is essential to optimize intervention and patient care.
