A Case of Budd-Chiari Syndrome Associated with Alveolar Echinococcosis
A 62-year-old female patient admitted to our clinic because of recent fatigue, shortness of breath, abdominal distention, and pain in the right upper quadrant. In her history, she had a liver wedge resection 3 years ago with AE found in the biopsy material. On physical examination, the liver was 5 cm palpable under the right rib, the spleen was non-palpable, and Traube's space was clear. Tension ascites and collateral veins in an upward flow direction were noted on the abdomen. Respiratory sounds were decreased at the bases of both lungs and dullness was found with percussion.\nHemoglobin was 8.3 g/dl in the whole blood count. Except for low albumin levels (2.1 g/dl), all other biochemical tests were normal. There was no flow viewed in the left hepatic vein and inferior vena cava on abdominal portal Doppler ultrasound. The portal vein was 16 mm, and the splenic vein was 15 mm in diameter and hepatofugal flow was noted. On contrasted abdominal CT, there was a 54×70×45 mm-sized cystic lesion in left lobe of the liver extending towards the posterior mediastinum with irregular calcifications that invaded the diaphragm, esophagus, and pericardium. It was occluding the inferior vena cava and left hepatic vein at the level where the hepatic veins poured into the inferior vena cava. Secondary to inferior vena cava occlusion, the azygos vein and the hemiazygos vein appeared to be dilated. There was bilateral pleural effusion (). A grade 1 esophageal varix was observed on upper endoscopy. The inferior vena cava was found to be occluded at the L1 level with venography. It was determined that the venous return was provided by the azygos, hemiazygos system, and the collaterals (). In the performed echocardiography, the entrance of the inferior vena cava into the right atrium was normal.\nWith paracenthesis, the intraperitoneal fluid was turbid and total leucocyte number was 410/mm3 (10% neutrophils, 90% lymphomonocytes). The intraperitoneal fluid was exudate in character (serum acid albumin gradient was 0.2 g/dl) and protein was 5.1 g/dl. There was no other pathology found in the Gram staining and culture of the intraperitoneal fluid.\nAccording to these findings, the patient was diagnosed with secondary Budd-Chiari Syndrome (BCS) development due to AE. The patient was given 15 mg/kg albendazole (800 mg/day) for treatment.