# Budd-Chiari syndrome following abdominal trauma

## TL;DR

A man developed Budd-Chiari syndrome after abdominal trauma from a donkey kick, leading to severe blood clots and successful surgical recovery.

## Contribution

Highlights a rare case linking abdominal trauma to Budd-Chiari syndrome and emphasizes its consideration in nephrotic syndrome patients.

## Key findings

- IVC thrombosis extended into the right atrium and caused pulmonary emboli.
- Surgical resection of clots in the right atrium and pulmonary arteries led to recovery.
- BCS should be considered in patients with nephrotic syndrome and unexplained clotting.

## Abstract

We report a case of Budd-Chiari syndrome (BCS) in a 44-year-old man with inferior vena cava (IVC) thrombosis and nephrotic syndrome. This case was complicated by right atrial clot and pulmonary emboli. Endothelial injury of the IVC was the likely mechanism, following a kick from a donkey. Abdominal ultrasonography revealed a large thrombosis located in a segment of IVC near its orifice in the right atrium. Transthoracic echocardiography (TTE) revealed IVC thrombosis that extended to the right atrium; however, pulmonary emboli (PE) were not documented in TTE. Intraoperative exploration revealed multiple clots in the main and left pulmonary artery branches. The patient recovered well after open-heart surgery with resection of the right atrium, IVC, and pulmonary artery emboli. BCS should be routinely considered for patients with nephrotic syndrome.