Images in Clinical Medicine

Kim Eagle, M.D., Editor

Hepatic Venous Obstruction by a Membranous Web

Kenji Kakizaki, M.D., and Hidemi Yamauchi, M.D.

N Engl J Med 1996; 334:1237May 9, 1996

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Article

Figure 1 Abdominal ultrasonography in a 25-year-old man who reported pain in the right upper quadrant on exertion (Panel A) revealed communicating vessels between the right (RHV) and middle (MHV) hepatic veins and a membranous septum (arrow) at the confluence of the middle and left (LHV) hepatic veins and the inferior vena cava (IVC). Color Doppler imaging confirmed the presence of reversed blood flow in the middle hepatic vein (red segment in Panel B), suggesting the Budd–Chiari syndrome. The diagnosis was confirmed by inferior venacavography (Panel C), which revealed a membranous septum (arrow), about 1 mm thick, above the level of the liver. The patient was treated with percutaneous transluminal angioplasty. Abdominal pain completely disappeared after the procedure, as did the pressure gradient between the thoracic and abdominal inferior vena cava. He remains free of the symptoms 10 months later.

Kim Eagle, M.D.

Kenji Kakizaki, M.D.
Hidemi Yamauchi, M.D.
Sendai National Hospital, Sendai 983, Japan