Hepatic Venous Obstruction by a Membranous Web

Figure 1. Abdominal ultrasonography in a 25-year-old man who reported pain in the right upper quadrant on exertion (Panel A) revealed communicating vessels between the right (RHV) and middle (MHV) hepatic veins and a membranous septum (arrow) at the confluence of the middle and left (LHV) hepatic veins and the inferior vena cava (IVC). Color Doppler imaging confirmed the presence of reversed blood flow in the middle hepatic vein (red segment in Panel B), suggesting the Budd–Chiari syndrome. The diagnosis was confirmed by inferior venacavography (Panel C), which revealed a membranous septum (arrow), about 1 mm thick, above the level . . .