Hepatocellular Carcinoma With Presentation of Budd-Chiari Syndrome

Received 26 May 2009; accepted 10 November 2009.

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

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References

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a Division of Gastroenterology, Department of Medicine, Taipei, Taiwan, R.O.C.

b Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.

c Division of Gastroenterology, Department of Medicine, Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan, R.O.C.

d Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.

e Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.

Correspondence 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.

† Wei-Yu Kao and Hung-Hsu Hung contributed equally to this work.

PII: S1726-4901(10)70008-3

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

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