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Multiple liver lesions in a patient with Budd-Chiari syndrome secondary to polycythemia vera

Juan Putra, Arifa Toor, Todd A. Noce, Swan N. Thung, Arief A. Suriawinata, Mikhail Lisovsky

Abstract

Focal nodular hyperplasia and nodular regenerative hyperplasia are occasionally seen in patients with hepatic venous outflow obstruction as a consequence of circulatory stress in the liver. In addition, neoplastic processes such as hepatic adenoma, hepatocellular carcinoma, and metastatic disease may arise in these patients. Histologic evaluation is necessary when imaging modalities are unable to distinguish these lesions. We present a case of multiple hepatic lesions, suspicious for metastases, in a patient with Budd-Chiari syndrome secondary to polycythemia vera. However, the biopsy findings were consistent with focal nodular hyperplasia. Budd-Chiari syndrome may be associated with multiple nodules of focal nodular hyperplasia, which may be difficult to diagnose radiologically.

Key words. Focal nodular hyperplasia., Nodular regenerative hyperplasia., Hepatic vein thrombosis., Benign hepatic lesion.

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The Official Journal of the Mexican Association of Hepatology, the Latin-American Association for the Study of the Liver and the Canadian Association for the Study of the Liver

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