Liver, Venous outflow obstruction, trichrome stain

Budd Chiari syndrome is induced by thrombotic or non-thrombotic obstruction, and many patients have an underlying thrombotic diathesis.

Sections show zonal necrosis (zone 3) with congestion. The final diagnosis rendered is "venous outflow obstruction", which reflects how small vs. large-vessel diseases cannot be distinguished. Causes of small vessel disease include iatrogenic (e.g. chemo-/radiotherapy-related). Large vessel causes include Budd-Chiari syndrome. Imaging is often used to diagnose the Budd-Chiari syndrome, which was the diagnosis in this case (acute on chronic).

This slide shows trichrome stain. See related content for H&E stain.