Sinusoidal obstruction diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Husnain Shaukat, M.D [2]

Overview

The two established criteria for the clinical diagnosis of sinusoidal obstruction syndrome are Baltimore criteria and modified Seattle criteria. The most accurate method to confirm the diagnosis and evaluate the severity of sinusoidal obstruction syndrome is the measurement of the hepatic venous gradient pressure (HVGP).

Diagnostic Criteria

The diagnosis of sinusoidal obstruction syndrome should be considered in any patient who has undergone hematopoietic cell transplant and develops liver dysfunction.

• The two established criteria for the clinical diagnosis of sinusoidal obstruction syndrome are:

Baltimore Criteria	Seattle criteria
Within 30 days of transplantation, bilirubinemia > 34.2 mol/L (2 mg/dL), plus 2 other findings among the following: Hepatomegaly, usually painful  > 5% weight gain Ascites	Within 20 days of transplantation, two of three findings among the following: Bilirubin > 34.2 mol/L (2 mg/dL) Hepatomegaly or RUQ pain of liver origin > 2% weight gain due to fluid accumulation

Diagnostic study of choice

Portal hepatic venous gradient

• The most accurate method to confirm the diagnosis and evaluate the severity of sinusoidal obstruction syndrome (SOS) is the measurement of the hepatic venous gradient pressure (HVGP) through the jugular vein.
• The portal-hepatic venous pressure gradient is defined as the difference between the wedged and free hepatic venous pressure, it can be measured at the time of transjugular liver biopsy.
• A hepatic venous gradient pressure (HVGP) ≥10 mmHg in a patient without previous liver disease is seen almost exclusively in sinusoidal obstruction syndrome (SOS).