Early retrograde enhancement of dilated inferior vena cava (IVC) and hepatic veins (HVs)
Heterogeneous, mottled, reticulated, mosaic hepatic parenchymal pattern
Periportal low attenuation (perivascular lymphedema)
Hepatomegaly and ascites
•
US: Loss of normal triphasic flow pattern
Spectral signal may have “M” shape
Cardiac cirrhosis: Flattening of Doppler wave form in hepatic veins
“To and fro” motion in hepatic veins and IVC
TOP DIFFERENTIAL DIAGNOSES
CLINICAL ISSUES
•
Passive hepatic congestion usually secondary to
Congestive heart failure
Constrictive pericarditis
Tricuspid insufficiency
Right heart failure
•
Radiologists may be 1st to recognize cardiac source of liver disease
•
Diagnosis is based on clinical and imaging findings
DIAGNOSTIC CHECKLIST
•
Differentiate acute passive hepatic congestion from Budd-Chiari and viral hepatitis
•
Distinguish chronic, cardiac cirrhosis from other etiologies
TERMINOLOGY
Synonyms
•
Congested liver in cardiac disease
Definitions
•
Stasis of blood within liver parenchyma as result of impaired hepatic venous drainage
IMAGING
General Features
•
Best diagnostic clue
Dilated hepatic veins with “to and fro” blood flow on color Doppler US
•
Key concepts
Hepatic manifestations of cardiac disease
–
Acute manifestation: Enlarged, heterogeneous liver
–
Late manifestation: Cardiac cirrhosis, small liver that may resemble cirrhosis of other causes
Passive hepatic congestion usually secondary to
–
Congestive heart failure (CHF)
–
Constrictive pericarditis
–
Tricuspid insufficiency
–
Right heart failure (e.g., pulmonary artery obstruction caused by lung cancer)
Characteristic sign on physical exam
CT Findings
•
Early retrograde enhancement of dilated inferior vena cava (IVC) and hepatic veins (HVs)
Due to contrast reflux from right atrium into IVC
•
Heterogeneous, mottled hepatic parenchymal pattern on arterial &/or venous phase CECT
Due to delayed enhancement of smaller hepatic veins
•
Peripheral, large, patchy areas of poor or delayed enhancement
•
Periportal low attenuation (perivascular lymphedema)
Decreased attenuation around intrahepatic IVC
•
Hepatomegaly and ascites
•
Chest findings vary by type of cardiac disease
Small heart due to constrictive pericarditis
Cardiomegaly due to valvular heart disease or cardiomyopathy
± pericardial or pleural effusions
MR Findings
•
T2WI
Periportal high signal intensity (periportal edema)
•
T1WI C+
Same dilated IVC and HVs as seen on CECT
Mottled hepatic enhancement
•
MRA
Slow or absent antegrade flow within IVC
Ultrasonographic Findings