Title : Ascitis
 
Clinical Problem : A 12 years old boy presented with progressive abdominal distension since 8 months and edema feet for 1 week. There is no jaundice, bleeding from any site or fever. He was treated with antituberculous therapy {ATT} for 3 months but had no relief. There is no history of blood transfusion or any other disorder in past. On examination, he has dilated veins over abdomen with flow below-upwards, massive ascitis and hepatosplenomegaly.
 
Question : What is the diagnosis
 
Expert Opinion : This child has ascitis along with dilated veins. The normal flow of blood over abdomen is away from umbilicus {i.e., below upwards above umbilicus and above downwards below umbilicus}. In portal hypertension also, the flow is away from umbilicus but veins are dilated and tortuous. In vena cava obstruction the flow of blood is from below upwards {i.e., below upwards both above and below the umbilicus}. In this child too, flow of blood is below-upwards suggestive of IVC obstruction. With development of ascitis, the diagnosis is Budd Chiari syndrome. The color Doppler of abdomen confirmed obstruction in the inferior vena cava.

E-published: Feb 2012 Vol 9 Issue 2 Art No. 10
 
Funding : None
 
Conflict of Interest : None
 
DOI No. : 10.7199/ped.oncall.2012.10
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