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Sinusoidal Obstruction Syndrome

(Veno-Occlusive Disease)

By

Whitney Jackson

, MD, University of Colorado School of Medicine

Last full review/revision Feb 2020| Content last modified Feb 2020
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Hepatic sinusoidal obstruction syndrome is caused by endothelial injury, leading to nonthrombotic occlusion of the terminal hepatic venules and hepatic sinusoids, rather than of the hepatic veins or inferior vena cava (as in Budd-Chiari syndrome Budd-Chiari Syndrome Budd-Chiari syndrome is obstruction of hepatic venous outflow that originates anywhere from the small hepatic veins inside the liver to the inferior vena cava and right atrium. Manifestations... read more ).

Etiology of Sinusoidal Obstruction Syndrome

Common causes include

Pearls & Pitfalls

  • Ask patients who have cryptogenic liver abnormalities about use of herbal and natural products (including bush and herb teas) and anabolic steroids (which can cause peliosis hepatis).

Symptoms and Signs of Sinusoidal Obstruction Syndrome

Diagnosis of Sinusoidal Obstruction Syndrome

  • Clinical evaluation and liver tests

  • Ultrasonography

  • Sometimes invasive tests (eg, liver biopsy, measurement of portal-hepatic venous pressure gradient)

The diagnosis is suspected in patients with unexplained clinical or laboratory evidence of liver disease, particularly in those with known risk factors, such as bone marrow or hematopoietic cell transplantation.

Laboratory results are nonspecific: elevated aminotransferase and conjugated bilirubin levels. Prothrombin time/international normalized ratio (PT/INR) becomes abnormal when disease is severe. Ultrasonography shows retrograde flow in the portal vein.

Treatment of Sinusoidal Obstruction Syndrome

  • Supportive care

  • Treatment of cause

  • For progressive disease, transjugular intrahepatic portosystemic shunting or transplantation

Management includes withdrawing the causative agent (such as herbal teas) and providing supportive therapy. Defibrotide, a sodium salt of single-stranded oligodeoxyribonucleotide, has been demonstrated to protect endothelial cells from further activation, and may be considered in patients with sinusoidal obstruction syndrome that complicates hematopoietic stem cell transplantation (1) Treatment reference Hepatic sinusoidal obstruction syndrome is caused by endothelial injury, leading to nonthrombotic occlusion of the terminal hepatic venules and hepatic sinusoids, rather than of the hepatic... read more .

Treatment reference

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Test your knowledge

Metastatic Liver Cancer
Liver metastases are common in many types of cancer, especially those of the GI tract, breast, lung, and pancreas. Symptoms of early liver metastases may be asymptomatic, and nonspecific symptoms often develop first. Which of the following symptoms of metastases is usually absent or mild until the terminal stage of the disease?
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