Triphasic helical CT in Budd-Chiari syndrome: 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, pitch 1.0) 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.