Severe acute exacerbation of hepatic vena cava syndrome: A recent large thrombus (T) and an older, organized thrombus (OT) can be seen in a stenosed inferior vena cava (IVC) with thick posterior wall at the site of hepatic vein opening resulting in hepatomegaly and ascites from hepatic venous outflow obstruction. The peritoneal wall is thick, indicating the presence of chronic peritonitis.ASC: Ascites; HV: Hepatic vein; PV: Portal vein.