Liver CT Appearances

Budd-Chiari Syndrome CT Findings

Patchy enhancement especially in arterial phase with increased enhancement of central portion of the liver
Enlarged caudate lobe
Compressed IVC
Absence of hepatic veins
Ascites
Regenerating nodules
Acute phase
- Early enhancement of caudate love and central portion of liver around IVC, with decreased enhancement of the rest of the liver
- Delayed enhancement of peripheral portions of liver and central portion of low density (called “flip-flop appearance”)
- Narrow hypodense hepatic vein and IVC with dense walls
Chronic
- Failure to visualize IVC or hepatic veins
- Intrahepatic collateral veins
- Heterogenous liver enhancement
- Large avidly enhancing regenerative nodules
- Marked caudate hypertrophy with peripheral atrophy