Nodular regenerative hyperplasia of the liver and the Budd-Chiari syndrome. Case report, review of the literature and reappraisal of pathogenesis

We report a case of nodular regenerative hyperplasia (NRH) of the liver associated with the Budd-Chiari syndrome in a patient whose clinical and radiological presentation suggested a diagnosis of multiple liver tumours. Based on both our study and a review of the literature, it appears that, in a number of cases of NRH associated with various clinical conditions, blood stasis at the sinusoidal level is the common denominator. We postulate that, in this situation, the prolonged exposure of hepatocytes to blood-borne hepatotrophic substances, such as hepatopoietins, glucagon and insulin, in combination with functional loss due to pressure injury within the congested areas, may be one of the mechanisms leading to the development of NRH.