Hepatic congestion secondary to right heart failure
Right upper quadrant pain with a palpable epigastric mass
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Enlarged liver with heterogeneous enhancement pattern on the portal venous phase. Note bilateral pleural effusions, distended hepatic veins and IVC, reflux of contrast from the right heart on the arterial phase entering the IVC and hepatic veins (a sign of right heart strain) and ascites.
Venous congestion of the liver occurs due to high right heart pressures impeding venous outflow via the hepatic veins into the IVC. The liver becomes enlarged and sometimes clinically pulsatile with a very heterogeneous enhancement pattern (mosaic in morphology).