Budd–Chiari syndrome caused by latent hepatic metastasis from a thymoma

A 34-year-old woman visited our hospital because she had had abdominal bloating for 2 months. She had been diagnosed with invasive thymoma (WHO pathological type B2), for which she had undergone chemotherapy and total thymectomy 10 years previously. Six years previously, pleural dissemination was diagnosed and she had undergone right extra-pleural pneumonectomy. On presentation to our hospital, abdominal computed tomography and ultrasound scans revealed abundant ascites and a huge liver lesion, likely a metastasis from her thymoma, obstructing the inferior vena cava. The serum–ascites albumin gradient was high at 1.4 g/dL, which indicated portal hypertension. We diagnosed Budd–Chiari syndrome caused by liver metastasis from a previous thymoma. Steroid therapy resulted in shrinkage of her liver tumor and a marked decrease in her ascites. Although rare, Budd–Chiari syndrome caused by liver metastasis from a thymoma is a possible serious complication of advanced invasive thymoma.