A 35-year-old woman presents with abdominal distension, right upper quadrant pain, and rapidly worsening ascites. She has a history of two spontaneous abortions. Ultrasound shows hepatomegaly with heterogeneous echotexture and absent flow in the hepatic veins. Which is the most likely underlying diagnosis?

• A Alcoholic cirrhosis
• B Portal vein thrombosis
• C Right-sided heart failure
• D Budd-Chiari syndrome ✓

Explanation

Budd-Chiari syndrome is hepatic venous outflow obstruction at the level of the hepatic veins or inferior vena cava. The classic triad is abdominal pain, hepatomegaly, and ascites. It is strongly associated with myeloproliferative disorders and hypercoagulable states, including antiphospholipid syndrome, which also causes recurrent pregnancy loss. Absent hepatic vein flow on Doppler ultrasound is diagnostic. Alcoholic cirrhosis and right heart failure do not show absent hepatic vein flow.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.