Hepatic congestion secondary to right heart failure

Case contributed by Dr Chris O'Donnell

Presentation

Right upper quadrant pain with a palpable epigastric mass

Patient Data

Age: 85
Gender: Male

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.

Case Discussion

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).

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Case Information

rID: 37411
Case created: 7th Jun 2015
Last edited: 2nd Nov 2016
Inclusion in quiz mode: Included

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