Passive hepatic congestion refers to the effects of impaired hepatic venous drainage due to cardiac disease. Cardiac failure and tricuspid v...
Passive hepatic congestion refers to the effects of impaired hepatic venous drainage due to cardiac disease. Cardiac failure and tricuspid valve disease are common causes. It may be a sign of right heart strain in the setting of pulmonary emboli.
• Hepatomegaly with distended hepatic veins and IVC when acute.
• ‘To-and-fro’ blood flow in hepatic veins on Doppler (note—this is when hepatic venous flow occurs in both anterograde and retrograde directions due to raised right-sided cardiac pressure; normal hepatic venous (HV) flow should just be anterograde [i.e. flowing towards the heart]).
• Chronic congestion may cause cirrhosis.
CT
• Enlarged liver with distended hepatic veins and IVC• Early filling of hepatic veins on arterial phase (due to reflux of contrast)• Patchy parenchymal heterogeneous enhancement on venous phase• Peri-portal low attenuation (oedema)• Ascites• Pleural effusions/cardiomegaly• Cirrhosis with or without its complications with chronic disease
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