Liver imaging: Budd-Chiari syndrome: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Liver imaging: Budd-Chiari syndrome

Sample item

A young woman with ascites and tender hepatomegaly has Doppler ultrasound showing absent flow in the hepatic veins and a caudate lobe enlargement. Which diagnosis is most likely?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Budd-Chiari syndrome

Hepatic venous outflow obstruction produces ascites, hepatomegaly and caudate enlargement, because the caudate has separate venous drainage into the IVC. Doppler shows absent or reversed flow and venous collaterals. A spider-web pattern of collaterals can be seen on venography.

Option by option

  • A. Hepatic adenoma

    Adenoma is a focal mass.

  • B. Budd-Chiari syndrome (correct)

    Correct. Absent hepatic vein flow with caudate hypertrophy is Budd-Chiari.

  • C. Portal vein thrombosis

    Portal vein thrombosis affects the portal vein, not the hepatic veins.

  • D. Cirrhosis from alcohol

    Alcoholic cirrhosis does not primarily cause absent hepatic vein flow.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is B, Budd-Chiari syndrome. Hepatic venous outflow obstruction produces ascites, hepatomegaly and caudate enlargement, because the caudate has separate venous drainage into the IVC.

Why is "Hepatic adenoma" not the answer?

Adenoma is a focal mass.

Why is "Portal vein thrombosis" not the answer?

Portal vein thrombosis affects the portal vein, not the hepatic veins.

Why is "Cirrhosis from alcohol" not the answer?

Alcoholic cirrhosis does not primarily cause absent hepatic vein flow.

What concept does this question test?

It tests Liver imaging: Budd-Chiari syndrome in Radiology. Doppler shows absent or reversed flow and venous collaterals. A spider-web pattern of collaterals can be seen on venography.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Liver imaging: Budd-Chiari syndrome?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.