Hepatic Vein Thrombosis

[Andiamo1]

I went to Mt Sinai for my yearly checkup and fibroscan.  The scan improved once again, but not so dramatically.
I have been going for an ultrasound to screen for HCC every 6 months, but this time, my doctor said I should have an MRI once a year and an ultrasound once a year.  There is lots of experience with SVR people and HCC rates following SVR and he felt this would provide better detection of any carcinoma.

The good news was that no cancer was detected.  The bad news is that I have blockage in the right hepatic vein, probably from a thrombosis.  I have no symptoms from this as the other veins are patent.  

So back to regular doctor visits and now an MRV monday morning.

[Andiamo1]

Thanks for the support.  Dr D is just going by the Fibroscan.   The gold standard is a biopsy, but I don't want any more of them.  My Fibroscan steadily improves, so that is why he is optimistic.  I might have had this for a long time.  I haven't had a scan of any type for many years.

I am not sure if Medicare will pay for the MRV.  I spent hours on the phone with them and they say they pay for any magnetic resonance test that is medically necessary, so we will see.

Even a biopsy can miss a section of the liver that is cirrhotic, since it only samples a small section.  I feel great though, so I am trying to be optimistic.

[HectorSF]

Hi. I am so very sorry to hear about this turn of events.
If there is anything I can do to help let me know.

Medicare should pay as MRI can show the detailed anatomy of the liver  and reveal the presence of hepatic vein thrombosis where ultrasound is better at seeing the complications that can arise with more serious thrombosis. Gallbladder wall thickening, ascites, patchy liver echo pattern, splenomegaly, hypertrophied caudate lobe.

As far as alternating MRI with ultrasound. That is what the procedure at my transplant center is. For many years I would have ultrasound then CT or MRI  alternating. Until I was diagnosed with HCC. Since then it is multi-phased MRI with contrast at least every three months. So I think alternating once a year is a good idea, although as you said the rates of HCC after SVR and much lower than those with active hep C.

Let us know how you are doing. My hope is for a swift treatment and recovery for you.

Hang in there. I know you over come this setback.
Howie

[rexx73]

sorry to jump in this thread,but can someone explain me if hepatic vein thrombosis is caused only by fibrosis/cirrhosis or are there other reasons to became this kind of blockage?

[Andiamo1]

Birth control pills caused it in some women during the late 60s.  I don't think the newer ones used today can cause it, but I am not sure.  I read lots of articles about it on the net, but none listed definitive causes.

[Andiamo1]

The good news is that the portal veins are patent as is the left hepatic vein.  No portal hypertension is visible in the scan, so I am puzzled about why the clot formed.  I will know more when I get the results of the MRV and talk to the docs.

[HectorSF]

You are right. Your situation seems good as far as thrombosis is concerned. I hope they can get a handle on it while it is still mild.

Have they concluded this is Budd–Chiari syndrome?

Causes
* The cause cannot be found in about half of the patients
* Primary (75%): thrombosis of the hepatic vein
* Secondary (25%): compression of the hepatic vein by an outside structure (e.g. a tumor)
* Hepatic vein thrombosis is associated with the following in decreasing order of frequency:
a) Polycythemia vera
b) pregnancy
c) post partum state
d) use of oral contraceptive
e) paroxysmal nocturnal hemoglobinuria
f) Hepatocellular carcinoma
g) Lupus anticoagulant
* Infection such as tuberculosis
* Congenital venous webs
* Occasionally inferior vena caval stenosis

The hepatic veins comprise of three large veins which are the right hepatic vein, the middle hepatic vein and the left hepatic vein drain the hepatic parenchyma into the IVC. There are separate small veins draining the caudate lobe of the liver.

* Right hepatic vein
The right hepatic vein runs at the right hepatic fissure and drains segments V, VI, VII and VIII. The plane of the right hepatic vein separates the segments VI and VII (which are posterior to this plane) and segments VIII and V (which are located anterior to this plane).

Variants
It is a single dominant vein in 60 - 78% individuals. There may be early bifurcation (splitting into 2 parts), early trifurcation (splitting into 3 parts)or even multiple right hepatic veins entering the IVC (inferior vena cava). This may make it difficult to deduce segmental anatomy of the liver.

Here is a good diagram of typical liver venus architecture.
http://livertransplantadvice.com/img/fig1.3_std.jpg


Hang in their buddy.
This is just a temporary bump in the road.
Howie