Congestive myelopathy secondary to epidural venous engorgement and venous congestion in a patient with Budd-Chiari syndrome and its management through inferior vena cava stenting.

Abstract

Budd-Chiari syndrome with obstruction in the inferior vena cava causes increased venous pressure in the azygous-hemiazygous system and paravertebral venous plexus, which is transmitted to the epidural venous plexus, devoid of the valves. It causes epidural venous plexus engorgement and venous congestion and may present rarely with low back pain or radiating pain. However, patients developing lower limb weakness as a complication of Budd-Chiari syndrome is an infrequent and severe presentation. Herein, we describe a case of Budd-Chiari syndrome with chronic inferior vena cava thrombosis in a patient in his 40s presenting with lower limb weakness, which improved after inferior vena cava stenting. In patients with back pain or lower limb weakness due to epidural venous engorgement and venous congestion, inferior vena cava occlusion secondary to Budd-Chiari syndrome should always be kept in mind, which can be treated successfully with endovascular stenting. Also, early intervention in Budd-Chiari syndrome can prevent permanent neurological deficits and the long-term complications of cirrhosis.