A young man with progressive jaundice and abdominal distension

Budd-Chiari syndrome (BCS) is a rare, life-threatening disease caused by obstruction of hepatic venous outflow. Common presentations are right upper quadrant pain, ascites, and hepatomegaly. A diagnosis of Budd-Chiari syndrome should be suspected when liver disease occurs in a patient with known risk factors for hypercoagulable state. We report a 22-years old transgender man presented with jaundice, marked ascites and hepatomegaly. Imaging studies showed complete thrombosis of all hepatic veins. Finally, he was diagnosed with Budd-Chiari syndrome with antiphospholipid syndrome.   Figure 1  ภาพ CT upper abdomen แสดงใหเหน marked ascites with heterogeneous liver enhancement, complete obliteration of all hepatic, caudate lobe hypertrophy, small intrahepatic venous collateral และ small arterial enhancing nodules