Budd-Chiari syndrome, or hepatic vein thrombosis, is usually seen in the context of underlying haematological disease or another procoagulant condition.

Causes:

• polycythaemia rubra vera
• thrombophilia: activated protein C resistance, antithrombin III deficiency, protein C & S deficiencies
• pregnancy
• combined oral contraceptive pill: accounts for around 20% of cases

PC

The features are classically a triad of:

• abdominal pain: sudden onset, severe
• ascites → abdominal distension
• tender hepatomegaly

Investigations

• ultrasound with Doppler flow studies is very sensitive and should be the initial radiological investigation