CASE 870 Published on 22.02.2001

Passive Hepatic Congestion

Section

Abdominal imaging

Case Type

Clinical Cases

Authors

P.M. Huismans, P.A. de Milliano, H.H. Kamerbeek

Patient

40 years, male

Categories

No Area of Interest ; Imaging Technique Ultrasound, CT

No Procedure ; No Special Focus ;

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Clinical History

One year history of abdominal discomfort, fatigue and dyspnea was admitted to the hospital for further evaluation.

Imaging Findings

A 40-year-old man with one year history of abdominal discomfort, fatigue and dyspnea was admitted to the hospital for further evaluation. On physical examination congestive heart failure was suspected. Chest radiographs (not shown) disclosed cardiomegaly with right atrial and bi-ventricular enlargement. Consecutively a cardiac ultrasonography and CT scan of the abdomen werely with rightatrial and bi-ventricular enlargement. Consecutively a cardiac ultrasonography and CT scan of the abdomen were the abdomen were performed.

Discussion

Passive hepatic congestion is caused by stasis of circulating blood within the liver parenchyma. This stasis occurs in all cases where the hepatic vein outflow is obstructed or in cases with occlusion of the small intrahepatic vessels. Cardiac decompensation, and more commonly, right heart failure are the most common causes of passive liver congestion. On plain chest radiographs the heart is generally enlarged and distended caval veins are often apparent. Pulmonary venous changes compatible with congestive lung disease are also obvious. Characteristic findings of passive hepatic congestion on bolus enhanced CT scans are hepatomegaly with typical mosaic pattern of the liver parenchyma and pronounced enhancement of the central portions of the liver. The hepatic veins usually cannot be identified on the initial images, during the early bolus phase. Ultrasonographic findings in passive hepatic congestion consist of hepatomegaly, marked enlargement of the inferior caval vein, dilated hepatic veins and systolic flow reversal into the liver veins, observed on the real time imaging. Other lesions which may cause an enlarged liver and passive congestion include chronic pulmonary disease, constrictive pericarditis, Budd-Chiari syndrome, and thoracic or cardial tumors causing compression of the inferior caval vein.

Differential Diagnosis List

Passive Hepatic Congestion

Final Diagnosis

Passive Hepatic Congestion

References

[1] Cooper MA, Arkles LB, Henessy OF et al. Congestive hepatomegaly-typical features on computed tomography, US and Nuclear Medicine. Austral Rad 1991; 35: 44-46. (PMID: 1859325)

[2] Gore RM, Mathieu DG, White EM et al. Passive hepatic congestion: cross-sectional imaging features. AJR 1994; 162: 71-75. (PMID: 8273693)

[3] Mauro MA, Stackhouse DJ, Parker A et al. CT of the hepatic venous hypertension: the reticulated-mosaic pattern. Gastrointest Radiol 1990; 15: 35-38. (PMID: 2298352)

Case information

URL:	https://eurorad.org/case/870
DOI:	10.1594/EURORAD/CASE.870
ISSN:	1563-4086

Figure 1

Parasternal, long axis echocardiogram

Cardiac ultrasonography shows(parasternal, long axis echocardiogram) a pronounced thickening of the myocardium of the right and left ventricule, indicating ventricular hypertrophy. On real time imaging during systole of the ventricules a severe tricuspid regurgitation is observed(la:left atrium; mitral valve(arrow); lv:left ventricule; Ao:aorta).

Transverse subcostal section demontrates dilated hepatic veins.

Figure 2

Computed Tomography of the liver

Contrast enhanced CT scan of the liver demonstrates (section at the level of hepatic veins) a grossly enlarged inferior caval vein and retrograde filling of the hepatic veins with contrast material.

Section through the liver shows characteristic mosaic pattern of hepatic parenchyma with peripheral low attenuation of the right hepatic lobe. The imaging findings on echocardiography and CT scan were suggestive for right cardiac failure due to tricuspid regurgitation and passive hepatic congestion.