Congestive cardiac failure

Case contributed by Dr Mostafa El-Feky

Presentation

Elevated liver function tests

Patient Data

Age: 60 years
Gender: Male
CT
  • cirrhotic liver
  • dilated inferior vena cava with reflux of contrast through it on arterial phase
  • dilated portal and splenic veins with multiple dilated venous collaterals at splenic hilum
  • mild splenomegaly
  • diffuse gallbladder wall edema
  • mild free ascites extending to lesser sac
  • diffuse mesenteric fat stranding
  • diffuse truncal subcutaneous edema
  • diffuse wall thickening of the urinary bladder with left-sided diverticulum
  • left inguinal hydrocele
  • large varicose veins at right femoral region draining at saphenofemoral junction

Scans through the base of the chest revealed:

  • multi-chamber enlargement of the heart with straightening of interventricular septum
  • right middle lobe abnormal tangle of blood vessels between dilated subsegmental pulmonary artery and vein, suggestive of pulmonary arteriovenous malformation 
  • sliding hiatal hernia

Case Discussion

The CT findings on this case are mostly due to congestive heart failure with cardiac-related cirrhosis, right-sided volume overload and development portal hypertension

Pulmonary arteriovenous malformations can occur in a variety of clinical situations, including liver and cardiac diseases, trauma and systemic disorders. They mostly occur in lower lung zones and subpleural location. 

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