Liver biopsy and histology is a useful investigation if liver transplantation is being considered as it helps identify the degree of hepatocellular damage and the degree of fibrosis. Findings on liver biopsy suggestive of Budd Chiari include high grade venous congestion, centrilobular liver cell atrophy, thrombi within the terminal hepatic venules, massive fibrosis in fulminant hepatic failure. Invasive imaging methods are used to identify obstruction of the venous outflow. Angiography of the inferior vena cava and hepatic veins can be used together with interventional therapeutic procedures to restore patency of the vessels.

Other diagnostic studies of Budd-Chiari syndrome are as follows:^[1][2]

• Liver biopsy and histology may be helpful in the diagnosis of Budd-Chiari syndrome.
• Liver biopsy and histology is a useful investigation if liver transplantation is being considered as it helps identify the degree of hepatocellular damage and the degree of fibrosis. Findings on liver biopsy suggestive of Budd Chiari include:
  • High grade venous congestion
  • Centrilobular liver cell atrophy
  • Thrombi within the terminal hepatic venules
  • Massive fibrosis in fulminant hepatic failure

• Angiography and venography may be helpful in the diagnosis of Budd-Chiari syndrome.
• Invasive imaging methods are used to identify obstruction of the venous outflow.
• Angiography of the inferior vena cava and hepatic veins can be used together with interventional therapeutic procedures to restore patency of the vessels.
• Findings on angiography suggestive of Budd Chiari include:
  • Hepatosplenomegaly
  • Stretched intra-hepatic arteries
  • Dilated hepatic arteries in patients with chronic disease, arteriovenous shunting in patients with chronic disease mottled appearance of liver
  • Sinusoidal contrast accumulation seen as large lakes is occasionally seen.
  • Cul-de-sac phenomenon consists of contrast material may progress slowly through the liver, often with outflow through the portal vein.
  • Portography shows central hepatic enhancement of the liver with normal hepatoportal flow.
  • Splenoportographic findings vary according to the duration of disease. In early stages of BCS, flow within the portal vein is centripetal, associated with delayed emptying and stretched portal vein radicles. In later stages of BCS, portal venous flow is reversed, and the splenic and portal veins may not fill.