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Gastroenterology
Budd-Chiari syndrome in a patient with antiphospholipid syndrome: hiding in plain sight
  1. Pedro Lages Martins1,
  2. Mário Jorge Silva1,2,
  3. Tiago Bilhim3 and
  4. Rita Ribeiro4
  1. 1Gastroenterology Department, Centro Hospitalar Universitario de Lisboa Central EPE, Lisboa, Portugal
  2. 2NOVA Medical School, Lisboa, Portugal
  3. 3Interventional Radiology Department, Centro Hospitalar Universitario de Lisboa Central EPE, Lisboa, Portugal
  4. 4Internal Medicine Department, Centro Hospitalar Universitario de Lisboa Central EPE, Lisboa, Portugal
  1. Correspondence to Dr Pedro Lages Martins; pb.lages.martins{at}gmail.com

Abstract

We describe the case of a woman in her 40s on lifelong anticoagulation with warfarin due to antiphospholipid syndrome presenting with acute right upper quadrant pain. Liver tests were only slightly elevated, and non-invasive imaging such as Doppler ultrasound and contrast-enhanced CT were non-diagnostic. As suspicion for a thrombotic complication persisted, repeat CT imaging ultimately confirmed the diagnosis of Budd-Chiari syndrome (BCS), and angiography was performed allowing for effective treatment with balloon angioplasty. This case highlights both the need for a high degree of clinical suspicion for BCS in patients with prothrombotic features (even those on anticoagulation) and also the diagnostic and therapeutic potential of interventional radiology in selected cases.

  • Interventional radiology
  • Liver disease
  • Portal hypertension

https://doi.org/10.1136/bcr-2024-259746

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    Footnotes

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: PLM and MJS. The following authors gave final approval of the manuscript: PLM, MJS, RR and TB. PM is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.