Budd-Chiari Syndrome and Dioctophyma renale

Longitudinal view of the hepatic and caval veins obtained from a right lateral coronal view. 
The caudal vena cava and hepatic veins are distended, with spontaneous venous flow that does not adequately progress toward the thorax.

Transverse hepatic image from a right lateral coronal view. 
At the junction of the central and left hepatic veins, a subacute thrombus with mixed echogenicity is present. This lesion causes critical stenosis and the development of acquired intrahepatic collateral vessels, visible as small transverse vascular structures.

Transverse hepatic image with magnification of the hepatic vein junction.
Magnified view of the junction between the central and left hepatic veins, showing the subacute thrombus and collateral vessels. These findings are consistent with primary radicular Budd-Chiari syndrome and post-hepatic portal hypertension.

Transverse hepatic image from a right lateral coronal view.
After two months of antiplatelet therapy (clopidogrel), follow-up examination demonstrated a reduction in thrombus size, while the venous collateral circulation remained evident.

Transverse hepatic image from a right lateral coronal view.
The venous thrombus decreased in size and echogenicity and become adherent to the venous wall following treatment.

During the follow-up examination, a parasitic form of Dioctophyma renale was identified attached to the hepatic surface.