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Investigations

Authoring team

These include:

  • chest X-ray - enlarged azygous vein may be seen when there is caval obstruction
  • liver biopsy - characteristic histology with dilated central veins and sinusoids; pericentral necrosis; replacement of hepatocytes by red blood cells; or, lately, centrilobular fibrosis
  • ultrasound or CT scan - demonstrates hepatic vein occlusion with ascites
  • sampling of ascitic fluid - high protein content
  • liver isotopic scanning - except in patients with membranous obstruction of the vena cava - demonstrates absent function through most of the liver except for the caudate lobe which has a different drainage (directly to the vena cava through multiple small tributaries).
  • venography - demonstrates hepatic vein occlusion, often with a beak-like deformity at their orifice

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