Sonographic classification of draining pathways of obstructed hepatic veins in Budd-Chiari syndrome

ABSTRACT Purpose To describe and propose a sonographic classification of the blood‐draining pathways of obstructed hepatic veins in Budd‐Chiari syndrome. Methods This retrospective study included 206 patients with hepatic vein obstructions who underwent sonographic examination. We evaluated the afflicted hepatic veins, as well as the course, orifice, blood flow direction of draining veins, and communicating branches. Results were classified and compared with digital subtraction angiography and computed tomography angiography. Results Of 618 hepatic veins in 206 patients, 542 were obstructed. The blood‐draining pathways were classified as hepatic vein‐accessory hepatic vein (131/206), hepatic vein‐hepatic vein/accessory hepatic+hepatic vein (49/206), and, less frequently, collateral pathways (26/206). Blood was drained from obstructed hepatic veins to the inferior vena cava, right atrium, para‐umbilical veins, or hepatic subcapsular veins through communicating branches of various number and diameters. Doppler signals were obtained from the draining veins. Conclusions Sonography provides accurate information regarding the blood‐draining pathways of obstructed hepatic veins in Budd‐Chiari syndrome, which may be helpful for treatment and follow‐up. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42:134–142, 2014