To explore the clinical and imaging manifestations (CT or MR) of hepatic sinusoidal obstruction syndrome (HSOS), and improve the diagnosis of this disease.

The etiology, clinical manifestations, laboratory examinations and imaging findings of 40 HSOS patients admitted to the Fifth Medical Center of the PLA General Hospital from November 2010 to November 2019 were retrospectively analyzed.

Among the 40 HSOS patients, 31 had a clear history of drug use. Among them, "Tusanqi" took the most, accounting for 65.0%(26/40). Five cases were after liver transplantation, 1 case was after kidney transplantation, and 3 cases had unknown etiology. The main clinical manifestations were abdominal distension, fatigue, ascites, etc. In laboratory tests, the levels of aspartate aminotransferase (AST), γ-glutamyltransferase (GGT), total bilirubin (TBil) and direct bilirubin (DBil) were mainly increased, accounting for 60.0% (24/40), 77.5% (31/40), 75.0% (30/40) and 87.5% (35/40), respectively. Meanwhile, the level of carbohydrate antigen 125 (CA125) was significantly increased in 96.4%(27/28) patients, and elevated D-dimer levels were more common (95.2%, 20/21). Imaging manifestations showed diffuse enlargement of the liver. The enhanced scanning showed liver parenchyma "plate-like" and "map-like" uneven enhancement, obvious enhancement in delayed phase, high degree of enhancement of liver parenchyma around hepatic veins, showing characteristic "clover sign", hepatic vein stenosis or unclear display, compression inferior vena cava and thinning, often accompanied by ascites, pleural fluid, cholecystitis and other extrahepatic signs.

There are various causes of HSOS, and the main reason is taking "Tusanqi". Combined with the causes of the disease, clinical manifestations, laboratory examination and imaging manifestations, the correct diagnosis of the disease can be made.