Journal of the Chinese Medical Association
Volume 73, Issue 2 , Pages 93-96, February 2010

Hepatocellular Carcinoma With Presentation of Budd-Chiari Syndrome

  • Wei-Yu Kao

      Affiliations

    • Division of Gastroenterology, Department of Medicine, Taipei, Taiwan, R.O.C.
    • Wei-Yu Kao and Hung-Hsu Hung contributed equally to this work.
  • ,
  • Hung-Hsu Hung

      Affiliations

    • Division of Gastroenterology, Department of Medicine, Taipei, Taiwan, R.O.C.
    • Wei-Yu Kao and Hung-Hsu Hung contributed equally to this work.
  • ,
  • Hsueh-Chieh Lu

      Affiliations

    • Division of Gastroenterology, Department of Medicine, Taipei, Taiwan, R.O.C.
    • Division of Gastroenterology, Department of Medicine, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan, R.O.C.
  • ,
  • Han-Chieh Lin

      Affiliations

    • Division of Gastroenterology, Department of Medicine, Taipei, Taiwan, R.O.C.
    • Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
  • ,
  • Jaw-Ching Wu

      Affiliations

    • Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
  • ,
  • Shou-Dong Lee

      Affiliations

    • Division of Gastroenterology, Department of Medicine, Taipei, Taiwan, R.O.C.
    • Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
  • ,
  • Chien-Wei Su

      Affiliations

    • Division of Gastroenterology, Department of Medicine, Taipei, Taiwan, R.O.C.
    • Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr Chien-Wei Su, Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.

Received 26 May 2009; accepted 10 November 2009.

Article Outline

Budd-Chiari syndrome is defined as hepatic venous outflow obstruction at any level from the small hepatic veins to the junction of the inferior vena cava and the right atrium independent of the underlying disease. We report here a 40-year-old male patient who complained of abdominal fullness and bilateral lower leg edema for 1 month. A physical examination disclosed bilateral lower leg edema. Abdominal sonography revealed a small amount of ascites with thrombosis of the inferior vena cava and right hepatic vein. Viral hepatitis marker tests showed positive hepatitis B surface antigen. Tumor markers showed elevated serum a-fetoprotein levels. Computed tomography and magnetic resonance imaging confirmed hepatocellular carcinoma with inferior vena cava and right hepatic vein thrombosis. Therefore, hepatocellular carcinoma with Budd-Chiari syndrome was diagnosed. The patient was treated with intravenous heparin, which was then changed to oral warfarin. Although it is relatively rare, clinicians should be aware of hepatocellular carcinoma with Budd-Chiari syndrome when leg edema occurs without hypoalbuminemia in patients with chronic hepatitis B, because these patients are in the high-risk group for developing hepatocellular carcinoma. Regular follow-up of chronic hepatitis B, including biochemical and sonography surveillance, should be performed.

Key Words:  Budd-Chiari syndrome , hepatitis B virus , hepatocellular carcinoma

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Horton JD, San Miguel FL, Membreno F, Wright F, Paima J, Foster P, et al. Budd-Chiari syndrome: illustrated review of current management . Liver Int . 2008;28:455–466
  2. Valla DC . Budd-Chiari syndrome and veno-occlusive disease/sinusoidal obstruction syndrome . Gut . 2008;57:1469–1478
  3. Liu CJ , Kao JH . Hepatitis B virus-related hepatocellular carcinoma: epidemiology and pathogenic role of viral factors . J Chin Med Assoc . 2007;70:141–145
  4. Su CW, Wu JC, Chiou YY, Tsay SH, Huo TI, Huang YH, et al  Successful radiofrequency ablation therapy for hepatocellular carcinoma in a male patient with early stage primary biliary cirrhosis and positive serum hepatitis B core antibody . J Chin Med Assoc . 2008;71:40–44
  5. Tsai JJ , Su CW , Lin HC . Hepatocellular carcinoma with invasion into right atrium . Clin Gastroenterol Hepatol . 2008;6:e39–e40
  6. Sasaki A, Kai S, Endo Y, Iwaki K, Uchida H, Shibata K, et al  Hepatitis B virus infection predicts extrahepatic metastasis after hepatic resection in patients with large hepatocellular carcinoma . Ann Surg Oncol . 2007;14:3181–3187
  7. Jang JW , Yoon SK , Bae SH , Choi JY , Chung KW , Sun HS . Rapidly progressing Budd-Chiari syndrome complicated by hepatocellular carcinoma . Korean J Intern Med . 2003;18:191–195
  8. Kage M . Budd-Chiari syndrome and hepatocellular carcinoma . J Gastroenterol . 2004;39:706–707
  9. Wörns MA, Weinmann A, Pfingst K, Schulte-Sasse C, Messow CM, Schulze-Bergkamen H, et al  Safety and efficacy of sorafenib in patients with advanced hepatocellular carcinoma in consideration of concomitant stage of liver cirrhosis . J Clin Gastroenterol . 2009;43:489–495
  10. Boozari B , Bahr MJ , Kubicka S , Klempnauer J , Manns MP , Gebel M . Ultrasonography in patients with Budd-Chiari syndrome: diagnostic signs and prognostic implications . J Hepatol . 2008;49:572–580
  11. Bargallo X , Gilabert R , Nicolau C , Garcia-Pagan JC , Ayuso JR , Bru C . Sonography of Budd-Chiari syndrome . AJR Am J Roentgenol . 2006;187:W33–W41
  12. Valla DC . Primary Budd-Chiari syndrome . J Hepatol . 2009;50:195–203
  13. Garcia-Pagan JC, Heydtmann M, Raffa S, Plessier A, Murad S, Fabris F, et al  TIPS for Budd-Chiari syndrome: long-term results and prognostics factors in 124 patients . Gastroenterology . 2008;135:808–815
  14. Mentha G, Giostra E, Majno PE, Bechstein WO, Neuhaus P, O'Grady J, et al  Liver transplantation for Budd-Chiari syndrome: a European study on 248 patients from 51 centres . J Hepatol . 2006;44:520–528
  15. Segev DL, Nguyen GC, Locke JE, Simpkins CE, Montgomery RA, Maley WR, et al. Twenty years of liver transplantation for Budd-Chiari syndrome: a national registry analysis . Liver Transpl . 2007;13:1285–1294
  16. Murad SD, Valla DC, de Groen PC, Zeitoun G, Hopmans JA, Haagsma EB, et al  Determinants of survival and the effect of portosystemic shunting in patients with Budd-Chiari syndrome . Hepatology . 2004;39:500–508

PII: S1726-4901(10)70008-3

doi:10.1016/S1726-4901(10)70008-3

Journal of the Chinese Medical Association
Volume 73, Issue 2 , Pages 93-96, February 2010