In Reply to: Case 0100_06 -- Symptomatic Pulmonary Embolus in a Patient after IVC Filter Placement posted by Editor on December 30, 1999 at 14:22:14:
i believe the etiology of this patients acute exacerbation of symptoms was related to budd chiari syndrome. there are ct signs such as prominent caudate lobe which support the diagnosis as well as your venography. acute pv occlusion tends to cause problems directly related to portal hypertension as well as mesenteric vein ischemia rather than hepatocellular dysfunction as this patient had. tips was a very reasonable treatment option as re establishing hepato pedal pv flow in this case even if some were shunted away through the tips was important to restoring liver function. i might have considered simply stenting beyond the thrombus at the time of the original tips rather than administering lytics. due to the large porta systemic collaterals giving lytics via the sma probably would not have worked very well. hepato pedal flow may also have been potentiated in this case by embolizing these collaterals at the time of the tips.