Acute Budd-Chiari syndrome associated with non-viral cryptogenic hepatocellular carcinoma: revisiting the 'chicken or the egg' theory.

Budd-Chiari syndrome is an eponym for "hepatic venous outflow tract obstruction". BCS left untreated has a high mortality rate. Diagnosis can be difficult because of the wide spectrum of presentation of the disease and the varying severity of liver damage. The onset of disease may be insidious, with a chronic, asymptomatic course, or also present on other occasions as an acute, life-threatening condition. In rare instances, BCS is associated with hepatocellular carcinoma (HCC), which may be both a cause and a consequence of BCS. Presented here is a case of acute, rapidly fatal severe BCS associated with HCC. The association between BCS and HCC in 'the chicken or the egg' analogy is revisited.