Congestive hepatopathy is a post-sinusoidal pathologic condition, and may be caused by hepatic vein/IVC thrombosis (Budd Chiari syndrome), right heart failure, severe tricuspid regurgitation or constrictive pericarditis. Hepatomegaly or ascites may be present. Labs show a variable rise in transaminases and an indirect hyperbilirubinemia.
The appearance of the liver is mottled, and sometimes referred to as a nutmeg liver. Due to hepatic vein and sinusoidal congestion, contrast does not flow through the liver in a normal manner; it is often noted in arterial phases of a dynamic CT or MRI.
In the radiograph above, the texture of hepatic parenchyma is clearly heterogenious, without any discrete lesions noted. This suggests a perfusion anomaly. Particular attention should then be paid to the post-sinusoidal vasculature (ie. hepatic veins, IVC) to ensure there is no obstruction.