When should vascular liver disease be considered? 25
Jérôme Dumortier , Maxime Ronot , Aurélie Beaufrère .Abstract
Vascular liver diseases (VLD) are rare and their diagnosis can be difficult and late, leading to a delay in treatment. Diagnosis is most often multidisciplinary, involving primarily the clinician but also the radiologist and pathologist. In all cases, attention should be drawn to the absence of the usual causes of liver disease; conversely, a context of pathology associated with VLD may be a suggestive factor. The two main ways in which porto-sinusoidal vascular disease is discovered are unexplained abnormal liver tests and portal hypertension (PHT) without cirrhosis. In the case of acute splanchnic thrombosis (mainly portal), the main symptom is abdominal pain. The intensity of symptoms varies greatly, and the diagnosis may be overlooked and established late, at the stage of portal cavernoma and possibly complications of PHT. Budd-Chiari syndrome can mimic any acute or chronic liver disease, with the most common presentation being ascites/hepatomegaly/abdominal pain. Many clinical situations should raise the suspicion of VLD, which is based on dialogue between the clinician, radiologist, and pathologist. Early diagnosis allows for optimal patient management, particularly through anticoagulant therapy and treatment of PHT.
