Hepatic venocclusive disease after bone-marrow transplantation: Diagnosis with duplex sonography

Venocclusive disease of the liver is a well-known complication of bone-marrow transplantation, especially in patients who have had combined chemotherapy and radiation therapy before transplantation. Histopathologic study shows occlusion at the terminal hepatic venules and sublobular veins and centrolobular necrosis. The major hepatic veins are not involved - a finding that distinguishes this entity from the classic Budd-Chiari syndrome. Clinical features include abdominal pain, hepatomegaly, ascites, jaundice, and encephalopathy. We describe a patient who had acute reversal of portal venous flow and visceral edema, which was documented on two duplex sonograms on consecutive days.