Thrombosis of the hepatic veins. "The Budd-Chiari syndrome"--a possible link between oral contraceptives and thrombosis formation.

A case report of a 23-year old previously healthly nulliparous female who developed an acute thrombosis of the hepatic veins (Budd-Chiari syndrome) 14 days after starting daily ingestion of Norinyl an oral contraceptive containing 2 mg norethindrone and .1 mg mestranol is presented. The drug was stopped by the physician as he felt that she had apparent sensitivity to the oral contraceptive as evidenced by nausea vomiting ascites and abdominal distress. Death occurred 12 days after hospital admission because of massive gastrointestinal hemorrhage from a ruptured esophageal varix. The major autopsy findings were those of anasarca and ascites thrombosis of the hepatic veins vena cava portal and azygos veins and hyperplastic bone marrow containing increased numbers of megakaryocytes exhibiting erythroid hyperplasia. The liver and spleen were two times enlarged. Autopsy proved that the hepatic vein thrombosis with vena caval thrombosis and associated liver failure were the basis for the esophageal varices which ruptured producing the terminal exsanguination. The report also deals with the clinical aspects of the case historical approach pathogenesis and the possible link between oral contraceptives and thrombosis.