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Budd-Chiari Syndrome — RACP Adult Medicine MCQ

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ModerateGastroenterologyBudd-Chiari SyndromeRACP Adult Medicine

A 55-year-old man with no prior liver history presents with new-onset ascites. He has hepatomegaly and bilateral leg oedema. CT shows massive hepatomegaly with a cauliflower pattern of hepatic vein thrombosis. SAAG is 15 g/L. Ascitic protein is 35 g/L (high protein ascites). What is the most likely diagnosis?

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Correct answer: E — Budd-Chiari syndrome

High SAAG (>11, indicating portal hypertension) with high ascitic protein (>25 g/L, unlike cirrhosis where protein is low) and hepatic vein thrombosis on CT is Budd-Chiari syndrome. The high protein reflects hepatic sinusoidal congestion without cirrhotic protein loss. Investigate for underlying thrombophilia (myeloproliferative neoplasm — JAK2 testing, antiphospholipid syndrome, PNH). Treatment: anticoagulation, TIPS, or liver transplant.

Reference: EASL – 2024 – Vascular Liver Disease; eTG GI 2024