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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 range from no symptoms to fulminant liver failure. If suspected, initial testing is Doppler ultrasonography. Treatment includes supportive medical therapy and measures to establish and maintain venous patency, such as thrombolysis, decompression with shunts, and long-term anticoagulation. Recent advances have changed our understanding of this disease, as well as the outcomes. In this review, we confine our discussion to primary BCS. Budd-Chiari syndrome is an uncommon condition induced by thrombotic or nonthrombotic obstruction of the hepatic venous outflow and is characterized by hepatomegaly, ascites, and abdominal pain. [1] See the image below. This condition is classified into primary Budd-Chiari syndrome, which results from thrombosis or inflammation of the hepatic vein walls, and secondary Budd-Chiari syndrome, caused by external compression or invasion, often due to malignancies.