The Budd-Chiari syndrome represents the obstruction of hepatic veins usually due to a hepatocarcinoma. We present the case of a 68 year old patient, in medical evidence for ten years with a Child A ethanolic liver cirrhosis, who was admitted in emergency for hematemesis and melena. Clinical examination and the laboratory findings at the admittance revealed signs of decompensated cirrhosis and severe anemia. Ultrasound examination showed a cirrhotic liver with portal hypertension signs and a multinodular mass in the right lobe of the liver with portal, biliary and right hepatic vein invasions extended to inferior caval vein. In upper digestive endoscopy stage IV esophageal varices were evidenced with signs of recent bleeding (sclerotherapy was performed) along with gastric varices and portal gastropathy. The particularity of the case consists in the invasive complications of the hepatocarcinoma regarding hepatic and inferior caval veins wich defines the Budd-Chiari syndrome (posthepatic portal hypertension added to the intrahepatic and prehepatic ones), the invasions of the biliary tract and portal vein being more frequent.