Hepatocellular Carcinoma and Splenic Artery Aneurysm Arising in a Patient with Budd-Chiari Syndrome: A Case Report

Chi-e Kitami, Isao Kurosaki, Naoyuki Yokoyama, Shinichi Kosugi, Katsuyoshi Hatakeyama and Kazuhiro Tsukada*

Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
Department of Surgery II, Toyama Medical and Pharmaceutical University*

We report a case of Budd-Chiari syndrome with membranous obstruction of the interior vena cava complicated by hepatocellular carcinoma and splenic artery aneurysm. A 51-year-old woman diagnosed with Budd-Chiari syndrome and undergoing percutaneous transluminal angioplasty (Brockenbrough method) in 1985 was found 16 years later in abdominal CT scan to have 2 masses, 2 cm in size, in segment S5 and S7-8 of the liver. They were diagnosed as hepatocellular carcinoma and treated with transcatheter arterial embolization in 2001. The next year, a splenic artery aneurysm at the hilus of the spleen had grown up to 3.3 cm in diameter. We resected the aneurysm and conducted splenectomy. Portal pressure was 21 cm H₂O. After surgery, pancytopenia disappeared. Histopathological examination of non cancerous liver tissue showed extensive loss of the parenchyma replaced by abundant collagen tissue in the hepatic venous radicles and portal tract. Long-standing portal hypertension and congestive liver damage caused by the outflow block of the hepatic vein, may thus contribute to the development of both hepatocellular carcinoma and splenic artery aneurysm.

Key words
Budd-Chiari syndrome, hepatocellular carcinoma, splenic artery aneurysm

Reprint requests
Chi-e Kitami Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
1-757 Asahimachi dori, Niigata, 951-8510 JAPAN

Accepted
April 28, 2004

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