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From question on page 1344
The is a case of angiomyolipoma of the liver causing Budd-Chiari syndrome. Angiomyolipomas are benign tumors commonly seen in the kidneys. In this patient it was an incidental finding detected on ultrasound. However, the tumour mass impinged on the hepatic veins causing hepatic venous outflow obstruction. The diagnosis is suggested by the rather acute onset of abdominal pain and ascitis and the presence of caudate lobe hypertrophy on computerised tomography scan. The findings of both fat and vascular tissue on magnetic reonance imaging suggest angiolipoma. The image shown is hepatic venography which shows absence of flow in the hepatic veins. The patient had a guided biopsy which showed fat and vascular tissue with marked immunoreactivity to smooth muscle actin and HMB-45 antibody, which is highly suggestive of angiomyolipoma.