Triphasic helical CT in Budd-Chiari sindrome: patterns of enhancement in acute, subacute and chronic disease

AIM: To retrospectively evaluate helical computed tomography (CT) findings in a series of consecutive patients with
Budd-Chiari syndrome.
METHODS: Patterns of enhancement observed at contrast-enhanced helical CT in 10 consecutive patients (six women,
four men; aged 27-51 years) with either acute, subacute or chronic Budd-Chiari syndrome were retrospectively
evaluated along with the status of the hepatic veins. All patients underwent triphasic helical CT (10 mm beam
collimation, 7 mm rec. intervals, 120 kV, 200-250 mA, pitchZ1.0) performed at 20-25, 70-75 and 300 s after i.v. bolus
(3 ml/s) injection of 150 ml iodinated non-ionic contrast media.
RESULTS: Abnormal patterns of enhancement were identified in eight patients. In all patients with acute Budd-Chiari
disease (3/3) abnormal arterial enhancement of the caudate lobe, the so-called "fan-shaped pattern" was observed,
whereas visible venous thrombosis was only depicted in two. Conversely, a "patchy pattern" of enhancement was
observed in five out of seven patients with either sub-acute (2) or chronic Budd-Chiari disease (5) along with a strip-like
appearance or lack of visualization of hepatic veins.
CONCLUSIONS: The "fan-shaped" pattern of enhancement represent a characteristic finding of acute Budd-Chiari
disease, and it may help to suggest the correct diagnosis even in absence of visible venous thrombosis.