Presentation
Free fluid in pelvis on FAST scan. Low Hb, ruptured ovarian cyst, spontaneous splenic rupture.
Patient Data
Arterial and portal venous phase CT abdomen and pelvis. The hepatic veins are attenuated, and the liver parenchyma demonstrates mottled attenuation on the portal venous phase with an enlarged caudate lobe. The spleen is enlarged. There is a moderate amount of simple fluid in the pelvis. Normal contrast opacification of the hepatic artery and portal vein. Normal remaining appearances.
Case Discussion
The above imaging findings are strongly suggestive of Budd-Chiari syndrome (based on mottled hepatic attenuation, caudate lobe enlargement, and splenomegaly), and the ascites likely relate to hepatic dysfunction.
Unfortunately, no liver function tests were performed in the emergency department.
The patient was immediately transferred to a specialist liver hospital and therefore could not be followed up.
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