Radiology: Congestive hepatopathy

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.

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