We report a case of a 37-year-old female who suffered from upper
abdominal pain, progressive abdominal distention,
shortness of breath, palpitation and pitting
edema of lower legs for more than one month. Abdominal sonography showed small caliber of hepatic veins, mild hepatosplenomegaly and moderate
ascites. Computed tomography of abdomen disclosed extensive thrombi in bilateral femoral veins, ovarian veins and inferior vena cava.
Ascites was transudate with normal cell count. Laboratory data showed
hypoalbuminemia, mild elevation of total
bilirubin and
iron deficiency anemia. Anti-
cardiolipin antibody was positive and
antinuclear antibody was negative. The histopathological features, including sinusoidal dilatation with atrophic change of adjacent hepatocytes, slight congestion and
hemosiderin-like material within the cytoplasm of Kupffer cells, were compatible with the criteria of
Budd-Chiari syndrome.
Heparin was intravenously administered immediately to prevent further progression of
thrombosis. The
ascites was successfully controlled with
diuretics (
spironolactone and
furosemide). After a two-week course of treatment, she was discharged in good condition and on
warfarin anti-
coagulant medication.