Hepatic venous return disorders

Introduction Hepatic venous return disorder is one of the symptoms of Budd-Chiari syndrome. Budd-Chiari syndrome refers to a clinical syndrome in which the hepatic vein or (and) the inferior vena cava of the hepatic segment is partially or completely obstructed, resulting in damage to the organ tissue caused by venous return. Usually it is a recessive onset, more than half of which has a history of 2 to 4 weeks, and then there are special symptoms and signs. The most common symptoms are dyspnea and facial edema. Followed by edema of the trunk and upper limbs, chest pain, cough, difficulty in swallowing.

Cause

(1) Causes of the disease

Most are caused by malignant tumors, such as primary mediastinal lymphoma of the lung cancer and metastatic tumors, chronic mediastinal inflammation, primary superior vena cava thrombosis, etc. can also cause SVCS.

(two) pathogenesis

The superior vena cava is located in the stenotic right anterior superior mediastinum, adjacent to the right main bronchus and ascending aorta in the posterior aspect of the sternum, surrounded by lymph nodes in the anastomosis with the azygous vein; the lymph of the entire right thoracic cavity and the lower left thoracic cavity flows through Lymph nodes. A variety of factors are associated with superior vena cava obstruction, malignant tumors of the mediastinum and paratracheal lymph nodes or metastatic diseased tumors directly infiltrating the vessel wall and/or intravascular thrombosis secondary to inflammation, blood stasis, platelet aggregation and other factors, can be produced by a single or a combination SVCS. Some patients may be accompanied by pleural effusion due to increased venous pressure and blocked lymphatic drainage.

an examination

Related inspection

Hepatic parenchymal imaging central venous pressure measurement (CVP) CT examination of liver, gallbladder and spleen CT

The clinical manifestations depend on the onset of illness, the degree of obstruction at the obstruction site, and the formation of collateral circulation. Usually more than half of the insidious onset has a history of 2 to 4 weeks and the special symptoms and signs are the most common symptoms of dyspnea, facial edema. Followed by the trunk and upper extremity edema, chest pain, cough and difficulty swallowing. Can also occur such as secondary intracranial pressure, there may be central nervous system symptoms, physical examination of thoracic jugular vein dilatation, facial edema, shortness of breath, may also have facial redness, upper extremity cyanosis and edema hoarseness and / or Horner Syndrome.

A diagnosis can be made based on a clinical examination of the clinical manifestations.

Differential diagnosis

Differential diagnosis of varicose veins and Budd-Chiari syndrome in lower extremities:

1. Budd-Chiari syndrome refers to a clinical syndrome in which the hepatic vein or (and) the inferior vena cava of the hepatic segment is partially or completely blocked, resulting in damage to the organ tissue caused by venous blood flow disorder. The main clinical manifestations were splenomegaly, massive and refractory ascites, esophageal varices often associated with hemorrhage, and thoracic wall varices.

2, both lower extremity edema and varicose veins, skin pigmentation, ulcers and so on. B-ultrasound showed: liver volume and caudate lobe increased, liver morphological abnormalities, hepatic vein stenosis and occlusion. In the clinical work, according to the patient's medical history, physical examination and B-ultrasound examination are performed carefully, and if necessary, vena cava cannulation can be performed for definite diagnosis.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.