Nutmeg liver

Case contributed by Bruno Di Muzio
Diagnosis certain


Incidental finding in a CT investigation for abdominal pain; left lower quadrant tender with guarding. Previous history of pancreatitis. Some epigastric tenderness, pancreatitis?

Patient Data

Age: 75 years
Gender: Female



Mild diffuse pancreatic duct dilatation, already identified on previous scans, and 14mm hypodensity in body/tail of the pancreas, stable with no features to suggest acute inflammatory process. Liver has heterogeneous enhancement likely perfusional/hepatic venous congestion, no focal lesions identified.

The spleen and adrenal glands are normal. Kidneys are malrotated and asymmetric due to a atrophic left kidney; no hydronephrosis.

US Liver


Gallbladder wall seen with no calculi visible. No bile duct dilatation ( CBD measures 5 mm ).

The liver is unremarkable in appearance. The pancreatic body/tail lesion could not be well evaluated.

Case Discussion

This case illustrates a mottled appearance of liver enhancement in the portal venous phase due to a cardiac congestive failure. This appearance is known as nutmeg liver. 

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