Acute Fulminant Hepatic Failure in the Setting of Acute Hepatic Vein Thrombosis: Hepatic Venous Outflow

Background: Obstruction of hepatic venous outflow results in the clinical phenomenon known as Budd-Chiari syndrome. Thrombosis is by far the leading cause of hepatic veins obstruction. Acute hepatic venous outflow obstruction can present with acute hepatic failure. Case: a 34-year-old male with recent history of IVC web/thrombus treated with thrombectomy/stenting 4 months ago and thrombectomy/right hepatic vein stenting 2 months ago. Patient presented with acute abdominal pain with imaging suggesting right hepatic vein and stent thrombosis, acute derangement of liver function test and elevated lactate. Doppler of the abdomen revealed no flow in the hepatic veins including hepatic vein stent and no flow in the portal veins. Right hepatic venogram showed patent hepatic vein with thrombosed right hepatic vein stent. CO₂ portogram showed no visualization of the portal vein. Then 4 mg TPA was instilled through the right hepatic vein and across the hepatic vein stent followed by angioplasty of the stent. Final Doppler showed patent hepatic vein and portal veins.

Discussion: Acute fulminant hepatic failure in the setting of Budd-Chiari syndrome is most likely due to thrombotic events. Interventional radiology plays a pivotal role in patient care. Hepatic venous outflow restoration may suffice to restore inflow in acute portal vein inflow slow flow/thrombus.

Publication History

Article published online:
09 February 2023