Nutmeg liver

Case contributed by Michael P Hartung


Elevated liver function tests. History of amyloidosis.

Patient Data

Age: 65 years
Gender: Female

Dilated right atrium. Some reflux of contrast into dilated IVC. Trace pericardial effusion. Medium right pleural effusion. 

Hepatic congestion evidenced by absent filling of dilated hepatic veins, despite good portal venous opacification (not due to timing). Hypoenhancing, edematous liver tissue resulting in reticulated liver architecture. 

Anasarca. Ascites. 

Case Discussion

Classic findings of nutmeg liver, likely due to restrictive cardiomyopathy in the setting of amyloidosis. 

Dilated right atrium, reflux into dilated IVC, absent filling of dilated hepatic veins despite good filling of the portal vein, and edema throughout liver parenchyma. 

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