Division of Gastroenterology, Department of Medicine, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2010 Feb;73(2):93-6. doi: 10.1016/S1726-4901(10)70008-3.
Budd-Chiari syndrome is defined as hepatic venous outflow obstruction at any level from the small hepatic veins to the junction of the inferior vena cava and the right atrium independent of the underlying disease. We report here a 40-year-old male patient who complained of abdominal fullness and bilateral lower leg edema for 1 month. A physical examination disclosed bilateral lower leg edema. Abdominal sonography revealed a small amount of ascites with thrombosis of the inferior vena cava and right hepatic vein. Viral hepatitis marker tests showed positive hepatitis B surface antigen. Tumor markers showed elevated serum a-fetoprotein levels. Computed tomography and magnetic resonance imaging confirmed hepatocellular carcinoma with inferior vena cava and right hepatic vein thrombosis. Therefore, hepatocellular carcinoma with Budd-Chiari syndrome was diagnosed. The patient was treated with intravenous heparin, which was then changed to oral warfarin. Although it is relatively rare, clinicians should be aware of hepatocellular carcinoma with Budd-Chiari syndrome when leg edema occurs without hypoalbuminemia in patients with chronic hepatitis B, because these patients are in the high-risk group for developing hepatocellular carcinoma. Regular follow-up of chronic hepatitis B, including biochemical and sonography surveillance, should be performed.
布加综合征定义为肝静脉流出道阻塞，病变部位可以是肝小静脉至下腔静脉和右心房交界处的任何水平，与潜在疾病无关。我们在此报告一例 40 岁男性患者，因腹胀和双侧小腿水肿 1 个月就诊。体格检查发现双侧小腿水肿。腹部超声显示少量腹水，伴下腔静脉和右肝静脉血栓形成。病毒性肝炎标志物检查示乙型肝炎表面抗原阳性。肿瘤标志物示血清甲胎蛋白水平升高。计算机断层扫描和磁共振成像证实为肝细胞癌伴下腔静脉和右肝静脉血栓形成。因此，诊断为肝细胞癌合并布加综合征。患者接受了静脉肝素治疗，随后改为口服华法林。虽然相对少见，但当慢性乙型肝炎患者出现无低蛋白血症的小腿水肿时，临床医生应意识到肝细胞癌合并布加综合征的可能性，因为这些患者是发生肝细胞癌的高危人群。应定期对慢性乙型肝炎进行随访，包括生化和超声监测。
