Acute Budd-Chiari syndrome is caused by thrombosis of hepatic veins and/or suprahepatic IVC. Occlusion of hepatic veins and severe ascites are the typical findings in acute Budd-Chiari syndrome. Liver parenchymal congestion leads to decreased and heterogenous liver enhancement, with the typical sparing of the caudate lobe that is drained directly into the IVC. Thrombosis may extend into the IVC, as is seen in this case. The patent IVC may also be compressed by the enlarged caudate lobe. 

Splenomegaly and concurrent portal hypertension are common associations.