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Fig. 5B —50-year-old man with secondary Budd-Chiari syndrome. Tumoral invasion of hepatic veins may be seen in hepatocellular carcinoma and other invasive tumors such as sarcoma. Extended hepatocarcinoma tends to invade vascular structures, although isolated invasion of hepatic vein does not have clinical correlation. Gray-scale sonogram obtained in right subcostal plane shows tumor invading middle hepatic vein (mhv). Thin arrows show vein invasion. Note presence of small vessels (thick arrows) going toward patent left hepatic vein (lhv). In this case, patient shows no symptoms associated with vascular infiltration.