Refined Ultrasound Diagnostic Criteria for Budd–Chiari Syndrome in High-Grade Occlusive Thrombosis of the Inferior Vena Cava.

Purpose : To improve the diagnostic efficacy of ultrasound (US) in detecting tumor thrombi in the inferior vena cava (IVC) and refine ultrasonographic criteria for Budd–Chiari syndrome (BCS) in patients with high-grade occlusive tumor thrombi of the IVC. Materials and methods : The study included 112 patients (36–78 years) with high-grade occlusive IVC thrombi. Inclusion Criteria: 1. Primary tumors (e.g., IVC leiomyosarcoma, renal cell carcinoma) associated with IVC thrombosis. 2. Instrumentally confirmed partial or complete occlusion of hepatic vein ostia. Ultrasound Protocol: B-mode imaging: Evaluation of thrombus echogenicity, structure, and extent; assessment of hepatic veins, IVC, and portal system. Doppler ultrasound: Analysis of blood flow direction and velocity in hepatic veins, IVC, and portal vein; diagnosis of hepatic vein occlusion. Liver elastometry: Fibrosis staging using METAVIR (F0–F4). Additional verification methods: correlation with computed tomography (CT) or magnetic resonance imaging (MRI) data and histopathological confirmation (in postoperative patients). Results : Absolute contraindications to surgery were identified in 6.25 % of patients (n = 7): Occlusive IVC thrombosis with impaired hepatic venous outflow. Hepatomegaly with structural parenchymal changes. METAVIR F4 fibrosis (cirrhosis). Decompensated portal hypertension (ascites, splenomegaly). In 93.75 % (n = 105), absence of cirrhosis enabled radical surgical intervention (tumor resection with thrombectomy). Elastometry confirmed a direct correlation between fibrosis severity and BCS progression (F4 fibrosis as a key predictor of non-operability). Conclusions : Refined ultrasound criteria for Budd–Chiari syndrome in patients with inferior vena cava (IVC) tumor thrombosis not only enhance diagnostic accuracy but also minimize the risk of unnecessary surgeries. Elastography and portal hemodynamic assessment are pivotal components of the diagnostic algorithm, significantly influencing clinical outcomes. Implementing these strategies into clinical practice will improve survival rates and reduce postoperative complication rates.