{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:03:33Z","timestamp":1756425813987,"version":"3.44.0"},"reference-count":19,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,4,11]]},"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:p>We describe the case of a woman in her 40s on lifelong anticoagulation with warfarin due to antiphospholipid syndrome presenting with acute right upper quadrant pain. Liver tests were only slightly elevated, and non-invasive imaging such as Doppler ultrasound and contrast-enhanced CT were non-diagnostic. As suspicion for a thrombotic complication persisted, repeat CT imaging ultimately confirmed the diagnosis of Budd-Chiari syndrome (BCS), and angiography was performed allowing for effective treatment with balloon angioplasty. This case highlights both the need for a high degree of clinical suspicion for BCS in patients with prothrombotic features (even those on anticoagulation) and also the diagnostic and therapeutic potential of interventional radiology in selected cases.<\/jats:p>","DOI":"10.1136\/bcr-2024-259746","type":"journal-article","created":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T15:20:15Z","timestamp":1745335215000},"page":"e259746","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Budd-Chiari syndrome in a patient with antiphospholipid syndrome: hiding in plain sight"],"prefix":"10.1136","volume":"18","author":[{"given":"Pedro Lages","family":"Martins","sequence":"first","affiliation":[{"name":"Gastroenterology Department, Centro Hospitalar Universitario de Lisboa Central EPE, Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M\u00e1rio Jorge","family":"Silva","sequence":"additional","affiliation":[{"name":"Gastroenterology Department, Centro Hospitalar Universitario de Lisboa Central EPE, Lisboa, Portugal"},{"name":"NOVA Medical School, Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiago","family":"Bilhim","sequence":"additional","affiliation":[{"name":"Interventional Radiology Department, Centro Hospitalar Universitario de Lisboa Central EPE, Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rita","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Centro Hospitalar Universitario de Lisboa Central EPE, Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,4,22]]},"reference":[{"key":"2025082802221171000_18.4.e259746.1","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/j.emc.2015.12.011","article-title":"Evaluating the Patient with Right Upper Quadrant Abdominal Pain","volume":"34","author":"Avegno","year":"2016","journal-title":"Emerg Med Clin North Am"},{"key":"2025082802221171000_18.4.e259746.2","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1111\/liv.14088","article-title":"Milestones in the discovery of Budd-Chiari syndrome","volume":"39","author":"Zanetto","year":"2019","journal-title":"Liver Int"},{"key":"2025082802221171000_18.4.e259746.3","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1055\/s-2002-23203","article-title":"Inferior vena cava thrombosis at its hepatic portion (obliterative hepatocavopathy)","volume":"22","author":"Okuda","year":"2002","journal-title":"Semin Liver Dis"},{"key":"2025082802221171000_18.4.e259746.4","doi-asserted-by":"crossref","first-page":"691","DOI":"10.4254\/wjh.v8.i16.691","article-title":"Redefining Budd-Chiari syndrome: A systematic review","volume":"8","author":"Shin","year":"2016","journal-title":"World J Hepatol"},{"key":"2025082802221171000_18.4.e259746.5","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1007\/s12072-017-9810-5","article-title":"Budd-Chiari syndrome\/hepatic venous outflow tract obstruction","volume":"12","author":"Valla","year":"2018","journal-title":"Hepatol Int"},{"key":"2025082802221171000_18.4.e259746.6","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1111\/bjh.19635","article-title":"Guidelines on the investigation and management of antiphospholipid syndrome","volume":"205","author":"Arachchillage","year":"2024","journal-title":"Br J Haematol"},{"key":"2025082802221171000_18.4.e259746.7","doi-asserted-by":"publisher","DOI":"10.1002\/art.10187"},{"key":"2025082802221171000_18.4.e259746.8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199504133321504"},{"key":"2025082802221171000_18.4.e259746.9","doi-asserted-by":"crossref","first-page":"1780","DOI":"10.1007\/s10620-020-06485-y","article-title":"An Update on the Management of Budd-Chiari Syndrome","volume":"66","author":"Sharma","year":"2021","journal-title":"Dig Dis Sci"},{"key":"2025082802221171000_18.4.e259746.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.07.040"},{"key":"2025082802221171000_18.4.e259746.11","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1097\/00005792-199401000-00003","article-title":"Hepatic outflow obstruction (Budd-Chiari syndrome). 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