Diagnostic Ultrasound - Abdomen and Pelvis

Budd-Chiari Syndrome
(Left) Color Doppler
ultrasound shows flow in the
intrahepatic IVC ſt but
expected inflowing hepatic
veins are not visualized,
consistent with Budd-Chiari.
(Right) Grayscale ultrasound
of the liver (left) shows a
somewhat narrowed and
echogenic right hepatic vein
. On color Doppler
ultrasound (right), no flow is
detected in the right hepatic
vein , consistent with Budd-
Chiari syndrome. Note
intrahepatic collateral vessels
st bypassing the occluded
hepatic vein.
Diagnoses: Liver
(Left) Color Doppler US of the
liver shows only the peripheral
right hepatic vein is visible
and is without detectable
vascularity. The expected
course of the more proximal
right hepatic vein also has no
detectable internal vascularity
ſt in this patient with Budd-
Chiari. (Right) Power Doppler
ultrasound in the same patient
confirms no detectable flow in
the right hepatic vein ſt.
Power Doppler is often more
sensitive for slow flow or
minimal flow and should be
employed for confirmation
when color Doppler fails to
detect vascularity.
(Left) Axial CECT shows a
hyperdense and slightly
hypertrophied caudate lobe
ſt in this patient with Budd-
Chiari syndrome. The caudate
is often spared in Budd-Chiari
because of its separate venous
drainage into the IVC. (Right)
Oblique angiography shows
"spider web" pattern of
intrahepatic collateralization
caused by hepatic vein
obstruction. Note tight
hepatic vein stenosis .
http://radiologyebook.com/
271