Buga syndrome is a clinical syndrome of impaired organ tissue stasis caused by partial or complete obstruction of the hepatic veins or (and) the inferior vena cava of the hepatic segment, resulting in impaired venous blood return. In the acute phase, patients have fever, right upper abdominal pain, rapid onset of massive peritoneal fluid, jaundice, hepatomegaly, tenderness in the liver area, and oliguria. The disease is more common in young men, with a male to female ratio of about (1.2 to 2):1, with an age range of 2.5 to 75 years, with 20 to 40 years being the most common. So what is the differential diagnosis of hepatic venous reflux disorder? Here is a brief introduction. Differential diagnosis of varicose veins of lower extremities and Buga syndrome Buga syndrome is a clinical syndrome of impaired stasis of organ tissues caused by partial or complete obstruction of the hepatic veins or (and) the inferior vena cava of the hepatic segment, resulting in impaired venous blood return. The main clinical manifestations are splenomegaly, massive and persistent ascites, esophageal varices often combined with bleeding, and varices in the thoracic wall. Ultrasound examination shows enlarged liver volume and caudate lobe, liver morphology, hepatic vein stenosis and occlusion. Clinical workup based on the patient’s history, careful physical examination as well as ultrasound and, if necessary, vena cava cannulation angiography, allows for a definitive diagnosis. Patients are advised to actively go to regular hospitals for systematic diagnosis and treatment to avoid misdiagnosis and unnecessary suffering.