Budd-Chiari syndrome associated with liver hydatid disease: retrospective evaluation of color Doppler US findings with emphasis on intrahepatic venous collateralization

Background. The purpose of this retrospective study is to evaluate the color Doppler US (CDUS) findings of Budd-Chiari Syndrome (BCS) associated with hydatid disease of the liver (HDL) with a special emphasis on the intrahepatic venous collateralisation. Methods. Digitally stored CDUS videoclips or videotape records of the liver of 13 patients with HDL and BCS were retrospectively reviewed. A special emphasis was placed on intrahepatic venous collaterals compatible with BCS. Results. During the retrospective analysis of the sonographic data, at least one type of intrahepatic venous collateral typical for BCS was detected in all patients. CDUS revealed 5 different types of intrahepatic venous collaterals including subcapsular veins, comma-shaped veins which sometimes resemble hockey-stick, spider-web collaterals, fragmented veins and linear veins distributed in a non-anatomical fashion. The most frequently encountered collaterals at CDUS were comma-shaped veins, seen in 12 of 13 (92.3%) patients. In addition, at least 2 different types of intrahepatic collaterals were found in 8 of 13 (61.5%) patients. In two patients, venous collaterals were not seen on gray-scale sonography, but they were apparent at CDUS. Conclusions. BCS secondary to HDL may come as an unexpected finding during sonography. Familiarity with the typical sonographic appearances of the intrahepatic venous collaterals associated with BCS may enable the correct diagnosis and the prompt further treatment. We recommend CDUS to be performed in every patient with HDL regardless of the clinical presentation.