J Liver Cancer.  2022 Sep;22(2):202-206. 10.17998/jlc.2022.09.17.

Multidisciplinary approach for hepatocellular carcinoma arising from cirrhotic liver with Budd-Chiari syndrome: a case report

• Kim S
• Kim JH
• Han JW
• Jang JW
• Choi JY
• Yoon SK
• Sung PS

• KMID: 2534248
• DOI: http://doi.org/10.17998/jlc.2022.09.17

Abstract

Budd-Chiari syndrome (BCS) is defined by the obstruction of the hepatic venous outflow between the small hepatic veins and the junction of the inferior vena cava (IVC) with the right atrium. BCS with IVC obstruction occasionally progresses to hepatocellular carcinoma (HCC). Here, we report the case of a patient with HCC arising from a cirrhotic liver with BCS, in whom the hepatic portion of the IVC was obstructed, and who had a favorable outcome with a multidisciplinary approach and IVC balloon angioplasty.

Keyword

Budd-Chiari syndrome; Carcinoma, hepatocellular; Inferior vena cava; Multidisciplinary; Case report

Figure

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  Figure 1. (A) Initial contrast-enhanced abdominal cT shows collapse of the hepatic portion of the IVc (arrow). (B) Initial IVc venography shows occlusion of the hepatic portion of the IVc (arrows). cT, computed tomography; IVc, inferior vena cava.

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  Figure 2. Initial magnetic resonance imaging of the liver demonstrated two tumors with the longest diameter of approximately 4.6 cm and 1.7 cm in S4 and S7, respectively, with typical radiological features. (A) Hypervascularity in arterial phase (left), washout in transitional phase (middle), and defect in hepatobiliary phase (right) after dynamic contrast enhancement (arrows). (B) High signal intensity in high b value image (left), diffusion restriction (right) in diffusion weighted image (arrows).

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  Figure 3. Initial transarterial chemoembolization being performed to treat hepatocellular carcinoma (arrows).

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  Figure 4. (A) collapsed hepatic portion of the IVc seen through IVc venography (arrow). (B) Balloon angioplasty being performed through IVc venography (arrow). (c) The collapsed IVc has been dilated after balloon angioplasty. IVc, inferior vena cava.

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  Figure 5. No viable lesions observed on the last liver magnetic resonance imaging, performed 39 months after the initial treatment.

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