Hepatic congestion: changes to portal vein flow

Case contributed by Chris O'Donnell


Past history severe cardiac disease. Now right upper quadrant pain and abnormal liver function.

Patient Data

Age: 75
Gender: Male

Enlarged heterogeneous parenchyma liver with edema in the gall bladder wall. Right sided pleural effusion. Enlarged IVC and hepatic veins ("Playboy bunny sign") with pulsatile flow in these veins as well as similar pulsatile flow in the main portal vein and its branches.

Gross globular cardiomegaly with right sided pleural effusion. Previous cardiac surgey and pacemaker.

Case Discussion

Heart failure leads to both morphological and functional changes in the liver. Hepatic congestion due to right heart failure and/or triscuspid regurgitation is a prominant feature and a reflection of elevated right atrial pressure. Secondary flow changes can occur in the portal vein and its branches reflecting the high pulstaile hepatic venous pressure waves.

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