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Budd-Chiari syndrome: Epidemiology, clinical manifestations, and diagnosis

Author
Michelle Lai, MD, MPH
Section Editor
Sanjiv Chopra, MD, MACP
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF

INTRODUCTION

Budd-Chiari syndrome is defined as hepatic venous outflow tract obstruction, independent of the level or mechanism of obstruction, provided the obstruction is not due to cardiac disease, pericardial disease, or sinusoidal obstruction syndrome (veno-occlusive disease) [1]. Primary Budd-Chiari syndrome is present when there is obstruction due to a predominantly venous process (thrombosis or phlebitis), whereas secondary Budd-Chiari is present when there is compression or invasion of the hepatic veins and/or the inferior vena cava by a lesion that originates outside of the vein (eg, a malignancy).

This topic will review the epidemiology, clinical manifestations, and diagnosis of Budd-Chiari syndrome. The etiology and treatment of Budd-Chiari syndrome are discussed separately. (See "Etiology of the Budd-Chiari syndrome" and "Budd-Chiari syndrome: Management".)

EPIDEMIOLOGY

Studies suggest that in the West, Budd-Chiari syndrome is more common in women and usually presents in the third or fourth decade of life (although it may occur in children or older adults) [2,3]. By contrast, in Asia, there is a slight predominance of men, with a median age of 45 years at presentation. In the West, pure hepatic vein blockage is more common, whereas in Asia, pure inferior vena cava or combined inferior vena cava and hepatic vein blockage predominate [3,4].

One of the largest published series from the West included 237 patients who had been treated for Budd-Chiari syndrome at four centers (in the United States, the Netherlands, and France) between 1984 and 2001 [4]. Two-thirds of the patients were female, and the median age was 35 years (range 13 to 76 years). The location of the outflow obstruction was in the hepatic veins (62 percent), inferior vena cava (7 percent), or both (31 percent), and 34 patients (14 percent) had associated portal vein thrombosis.

CATEGORIZATION

Budd-Chiari syndrome is categorized by disease duration and severity [5,6]:

                   

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Literature review current through: Nov 2016. | This topic last updated: Wed Nov 02 00:00:00 GMT 2016.
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