Asian Journal of Research and Reports in Hepatology

Background: Budd–Chiari syndrome (BCS) results from hepatic venous outflow obstruction and is rarely associated with external compression by hepatic hydatid cysts. Small cysts at the hepatic dome may cause early venous indentation before thrombosis or classical radiological features develop.

Case Presentation: A 46-year-old woman from rural West Bengal presented with dull right upper-quadrant pain and abdominal fullness for two months. Triphasic computed tomography revealed a 40 × 25 mm non-calcified mixed solid-cystic lesion in segment VIII and a 4.7 mm simple cyst in segment II. The hepatic and portal veins were patent, but the segment VIII lesion abutted and indented the right hepatic vein near its junction with the inferior vena cava. Doppler ultrasound demonstrated mildly reduced phasic flow without thrombus. In view of endemic exposure, weakly positive Echinococcus IgG, and imaging findings, an early or transitional hepatic hydatid cyst with impending Budd–Chiari physiology was suspected. Because hepatobiliary surgery was unavailable and the patient declined invasive treatment, cyclical albendazole therapy with clinical and sonological follow-up was undertaken.

Discussion: Over 18 months, the symptoms resolved, liver test results remained normal, and the lesion regressed, with normalisation of right hepatic venous Doppler flow. This case highlights the need for careful hepatic venous assessment in dome-based cystic liver lesions and suggests that selected small active cysts with early venous compression may be managed conservatively with close surveillance when invasive treatment is not feasible.