Gamna-Gandy bodies in congestive hepatopathy
60 year-old male presented with shortness of breath and a distended abdomen. Past medical history of cardiac transplant 9 years ago.
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Ultrasound study of the abdomen demonstrates heterogenous echogenicity of the liver with nodularity of the liver surface. There is moderate amount of ascities in the abdomen. The hepatic vein and IVC is massively dilated. The portal vein demonstrate antegrade flow and is of normal calibre. Multiple tiny echogenic foci are present in the spleen indicative of Gamna-Gandy bodies. The spleen is not enlarged.
Cardiac cirrhosis or more accurately known as congestive hepatopathy rarely satisfies strict criteria for cirrhosis. Decompensated right or biventricular heart failure causes transmission of elevated right atrial pressure to the IVC, hepatic veins and the liver. Chronic passive congestion leads to dilated hepatic venules with subsequent perisinusoidal fibrosis giving the so called "nutmeg" appearance on gross specimen. Although Gamna-Gandy bodies of the spleen is most commonly encountered in portal hypertension it can also occur in hepatic congestion without evidence of portal hypertension. The pathophysiological process of Gamna-Gandy bodies formation is thought to be the result of microhaemorhage resulting in haemosiderin and calcium deposition followed by fibroblastic reaction.