Advertisement

Abdominal Radiology

, Volume 43, Issue 8, pp 2037–2051 | Cite as

Congestive hepatopathy

  • Michael L. Wells
  • Sudhakar K. Venkatesh
Invited article

Abstract

Passive hepatic congestion may result from a variety of distinct cardiovascular conditions. Injury to the liver caused by congestion is often asymptomatic and may not be recognized clinically. Diagnosis of congestive hepatopathy is important as it has the potential to cause complications including hepatic fibrosis and development of benign and malignant liver masses. This review will summarize the pathophysiologic mechanisms of congestive hepatopathy and provide both description and examples of its multimodality imaging findings. Examples of alternative disease which may have a similar imaging appearance will be provided. Knowledge regarding the characteristic imaging findings of congestive hepatopathy will allow for its accurate identification. Reviewing both the benefits and limitations of imaging performed to evaluate congestive hepatopathy and its complications will help to avoid pitfalls and enable recommendation of appropriate next steps in diagnostic evaluation.

Keywords

Passive congestion Cardiac failure Cardiac cirrhosis CT MRI FNH-like nodules 

Notes

Compliance with ethical standards

Conflict of interest

Michael Wells and Sudhakar Venkatesh declare no conflict of interest.

Ethical approval

This is a review article only. This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Giallourakis CC, Rosenberg PM, Friedman LS (2002) The liver in heart failure. Clin Liver Dis 6(4):947–967CrossRefPubMedGoogle Scholar
  2. 2.
    Tanaka M, Wanless IR (1998) Pathology of the liver in Budd-Chiari syndrome: portal vein thrombosis and the histogenesis of veno-centric cirrhosis, veno-portal cirrhosis, and large regenerative nodules. Hepatology 27(2):488–496.  https://doi.org/10.1002/hep.510270224 CrossRefPubMedGoogle Scholar
  3. 3.
    Fan CQ, Crawford JM (2014) Sinusoidal obstruction syndrome (hepatic veno-occlusive disease). J Clin Exp Hepatol 4(4):332–346.  https://doi.org/10.1016/j.jceh.2014.10.002 CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Fredenburg TB, Johnson TR, Cohen MD (2011) The Fontan procedure: anatomy, complications, and manifestations of failure. Radiographics 31(2):453–463.  https://doi.org/10.1148/rg.312105027 CrossRefPubMedGoogle Scholar
  5. 5.
    Koehne de Gonzalez AK, Lefkowitch JH (2017) Heart disease and the liver: pathologic evaluation. Gastroenterol Clin North Am 46(2):421–435.  https://doi.org/10.1016/j.gtc.2017.01.012 CrossRefPubMedGoogle Scholar
  6. 6.
    Dunn GD, Hayes P, Breen KJ, Schenker S (1973) The liver in congestive heart failure: a review. Am J Med Sci 265(3):174–189CrossRefPubMedGoogle Scholar
  7. 7.
    Schiff ER, Maddrey WC, Sorrell MF (2011) Schiff’s diseases of the liver, 11th edn. Oxford: Wiley-BlackwellCrossRefGoogle Scholar
  8. 8.
    Shah H, Kuehl K, Sherker AH (2010) Liver disease after the Fontan procedure: what the hepatologist needs to know. J Clin Gastroenterol 44(6):428–431.  https://doi.org/10.1097/MCG.0b013e3181d476fc PubMedCrossRefGoogle Scholar
  9. 9.
    Sherlock S (1951) The liver in heart failure; relation of anatomical, functional, and circulatory changes. Br Heart J 13(3):273–293CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Wanless IR, Liu JJ, Butany J (1995) Role of thrombosis in the pathogenesis of congestive hepatic fibrosis (cardiac cirrhosis). Hepatology 21(5):1232–1237PubMedGoogle Scholar
  11. 11.
    Myers RP, Cerini R, Sayegh R, et al. (2003) Cardiac hepatopathy: clinical, hemodynamic, and histologic characteristics and correlations. Hepatology 37(2):393–400.  https://doi.org/10.1053/jhep.2003.50062 CrossRefPubMedGoogle Scholar
  12. 12.
    Wells ML, Fenstad ER, Poterucha JT, et al. (2016) Imaging findings of congestive hepatopathy. Radiographics 36(4):1024–1037.  https://doi.org/10.1148/rg.2016150207 CrossRefPubMedGoogle Scholar
  13. 13.
    Dai DF, Swanson PE, Krieger EV, et al. (2014) Congestive hepatic fibrosis score: a novel histologic assessment of clinical severity. Mod Pathol 27(12):1552–1558.  https://doi.org/10.1038/modpathol.2014.79 CrossRefPubMedGoogle Scholar
  14. 14.
    Louie CY, Pham MX, Daugherty TJ, Kambham N, Higgins JP (2015) The liver in heart failure: a biopsy and explant series of the histopathologic and laboratory findings with a particular focus on pre-cardiac transplant evaluation. Mod Pathol 28(7):932–943.  https://doi.org/10.1038/modpathol.2015.40 CrossRefPubMedGoogle Scholar
  15. 15.
    Wells ML, Hough DM, Fidler JL, et al. (2017) Benign nodules in post-Fontan livers can show imaging features considered diagnostic for hepatocellular carcinoma. Abdom Radiol (NY).  https://doi.org/10.1007/s00261-017-1181-9 CrossRefGoogle Scholar
  16. 16.
    Asrani SK, Warnes CA, Kamath PS (2013) Hepatocellular carcinoma after the Fontan procedure. N Engl J Med 368(18):1756–1757.  https://doi.org/10.1056/NEJMc1214222 CrossRefPubMedGoogle Scholar
  17. 17.
    Hilscher M, Sanchez W (2016) Congestive hepatopathy. Clin Liver Dis 8(3):68–71CrossRefGoogle Scholar
  18. 18.
    Kiesewetter CH, Sheron N, Vettukattill JJ, et al. (2007) Hepatic changes in the failing Fontan circulation. Heart 93(5):579–584.  https://doi.org/10.1136/hrt.2006.094516 CrossRefPubMedGoogle Scholar
  19. 19.
    Runyon BA (1988) Cardiac ascites: a characterization. J Clin Gastroenterol 10(4):410–412CrossRefPubMedGoogle Scholar
  20. 20.
    Kisloff B, Schaffer G (1976) Fulminant hepatic failure secondary to congestive heart failure. Am J Dig Dis 21(10):895–900CrossRefPubMedGoogle Scholar
  21. 21.
    Ferral H, Behrens G, Lopera J (2012) Budd-Chiari syndrome. AJR Am J Roentgenol 199(4):737–745.  https://doi.org/10.2214/AJR.12.9098 CrossRefPubMedGoogle Scholar
  22. 22.
    Henriksson L, Hedman A, Johansson R, Lindstrom K (1982) Ultrasound assessment of liver veins in congestive heart failure. Acta Radiol Diagn (Stockh) 23(4):361–363CrossRefGoogle Scholar
  23. 23.
    Moreno FL, Hagan AD, Holmen JR, et al. (1984) Evaluation of size and dynamics of the inferior vena cava as an index of right-sided cardiac function. Am J Cardiol 53(4):579–585CrossRefPubMedGoogle Scholar
  24. 24.
    Scheinfeld MH, Bilali A, Koenigsberg M (2009) Understanding the spectral Doppler waveform of the hepatic veins in health and disease. Radiographics 29(7):2081–2098.  https://doi.org/10.1148/rg.297095715 CrossRefPubMedGoogle Scholar
  25. 25.
    Wood MM, Romine LE, Lee YK, et al. (2010) Spectral Doppler signature waveforms in ultrasonography: a review of normal and abnormal waveforms. Ultrasound Q 26(2):83–99.  https://doi.org/10.1097/RUQ.0b013e3181dcbf67 CrossRefPubMedGoogle Scholar
  26. 26.
    Abu-Yousef MM, Milam SG, Farner RM (1990) Pulsatile portal vein flow: a sign of tricuspid regurgitation on duplex Doppler sonography. AJR Am J Roentgenol 155(4):785–788.  https://doi.org/10.2214/ajr.155.4.2119108 CrossRefPubMedGoogle Scholar
  27. 27.
    Gore RM, Mathieu DG, White EM, et al. (1994) Passive hepatic congestion: cross-sectional imaging features. AJR Am J Roentgenol 162(1):71–75.  https://doi.org/10.2214/ajr.162.1.8273693 CrossRefPubMedGoogle Scholar
  28. 28.
    Torabi M, Hosseinzadeh K, Federle MP (2008) CT of nonneoplastic hepatic vascular and perfusion disorders. Radiographics 28(7):1967–1982.  https://doi.org/10.1148/rg.287085067 CrossRefPubMedGoogle Scholar
  29. 29.
    Bae KT (2010) Intravenous contrast medium administration and scan timing at CT: considerations and approaches. Radiology 256(1):32–61.  https://doi.org/10.1148/radiol.10090908 CrossRefPubMedGoogle Scholar
  30. 30.
    Kavoliuniene A, Vaitiekiene A, Cesnaite G (2013) Congestive hepatopathy and hypoxic hepatitis in heart failure: a cardiologist’s point of view. Int J Cardiol 166(3):554–558.  https://doi.org/10.1016/j.ijcard.2012.05.003 CrossRefPubMedGoogle Scholar
  31. 31.
    Moller S, Bernardi M (2013) Interactions of the heart and the liver. Eur Heart J 34(36):2804–2811.  https://doi.org/10.1093/eurheartj/eht246 CrossRefPubMedGoogle Scholar
  32. 32.
    Holley HC, Koslin DB, Berland LL, Stanley RJ (1989) Inhomogeneous enhancement of liver parenchyma secondary to passive congestion: contrast-enhanced CT. Radiology 170(3 Pt 1):795–800.  https://doi.org/10.1148/radiology.170.3.2916031 CrossRefPubMedGoogle Scholar
  33. 33.
    Millonig G, Friedrich S, Adolf S, et al. (2010) Liver stiffness is directly influenced by central venous pressure. J Hepatol 52(2):206–210.  https://doi.org/10.1016/j.jhep.2009.11.018 CrossRefPubMedGoogle Scholar
  34. 34.
    Hopper I, Kemp W, Porapakkham P, et al. (2012) Impact of heart failure and changes to volume status on liver stiffness: non-invasive assessment using transient elastography. Eur J Heart Fail 14(6):621–627.  https://doi.org/10.1093/eurjhf/hfs044 CrossRefPubMedGoogle Scholar
  35. 35.
    Colli A, Pozzoni P, Berzuini A, et al. (2010) Decompensated chronic heart failure: increased liver stiffness measured by means of transient elastography. Radiology 257(3):872–878.  https://doi.org/10.1148/radiol.10100013 CrossRefPubMedGoogle Scholar
  36. 36.
    Chon YE, Kim SU, Park JY, et al. (2014) Dynamics of the liver stiffness value using transient elastography during the perioperative period in patients with valvular heart disease. PLoS ONE 9(3):e92795.  https://doi.org/10.1371/journal.pone.0092795 CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Yoneda M, Thomas E, Garcia-Buitrago MT, Schiff ER (2015) decreasing liver stiffness following pericardiectomy for constrictive pericarditis. Intern Med 54(16):2079–2080.  https://doi.org/10.2169/internalmedicine.54.4961 CrossRefPubMedGoogle Scholar
  38. 38.
    Poterucha JT, Johnson JN, Qureshi MY, et al. (2015) Magnetic resonance elastography: a novel technique for the detection of hepatic fibrosis and hepatocellular carcinoma after the fontan operation. Mayo Clin Proc.  https://doi.org/10.1016/j.mayocp.2015.04.020 PubMedCentralCrossRefPubMedGoogle Scholar
  39. 39.
    Venkatesh SK, Wells ML, Miller FH, Jhaveri KS, Silva AC, Taouli B, Ehman RL (In Press) Magnetic resonance elastography: beyond liver fibrosis- a case based pictorial review. Abdom RadiolGoogle Scholar
  40. 40.
    Shin NY, Kim MJ, Lim JS, et al. (2012) Accuracy of gadoxetic acid-enhanced magnetic resonance imaging for the diagnosis of sinusoidal obstruction syndrome in patients with chemotherapy-treated colorectal liver metastases. Eur Radiol 22(4):864–871.  https://doi.org/10.1007/s00330-011-2333-x CrossRefPubMedGoogle Scholar
  41. 41.
    Mohty M, Malard F, Abecassis M, et al. (2015) Sinusoidal obstruction syndrome/veno-occlusive disease: current situation and perspectives-a position statement from the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant 50(6):781–789.  https://doi.org/10.1038/bmt.2015.52 CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Kleber C, Buschmann CT (2013) Clinical implications of immediate or later periportal edema in MS-CT trauma scans: surrogate parameter of intravenous fluid status and venous congestion. Emerg Radiol 20(3):197–202.  https://doi.org/10.1007/s10140-012-1100-x CrossRefPubMedGoogle Scholar
  43. 43.
    Shanmuganathan K, Mirvis SE, Amoroso M (1993) Periportal low density on CT in patients with blunt trauma: association with elevated venous pressure. AJR Am J Roentgenol 160(2):279–283.  https://doi.org/10.2214/ajr.160.2.8424335 CrossRefPubMedGoogle Scholar
  44. 44.
    Boyd JH, Forbes J, Nakada TA, Walley KR, Russell JA (2011) Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med 39(2):259–265.  https://doi.org/10.1097/CCM.0b013e3181feeb15 CrossRefPubMedGoogle Scholar
  45. 45.
    Gore RM, Levine MS (2015) Textbook of gastrointestinal radiology, 4th edn. Philadelphia: ElsevierGoogle Scholar
  46. 46.
    Yoo SM, Lee HY, Song IS, et al. (2010) Acute hepatitis A: correlation of CT findings with clinical phase. Hepatogastroenterology 57(102–103):1208–1214PubMedGoogle Scholar
  47. 47.
    Chundru S, Kalb B, Arif-Tiwari H, et al. (2014) MRI of diffuse liver disease: characteristics of acute and chronic diseases. Diagn Interv Radiol 20(3):200–208.  https://doi.org/10.5152/dir.2014.13170 CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Bader TR, Beavers KL, Semelka RC (2003) MR imaging features of primary sclerosing cholangitis: patterns of cirrhosis in relationship to clinical severity of disease. Radiology 226(3):675–685.  https://doi.org/10.1148/radiol.2263011623 CrossRefPubMedGoogle Scholar
  49. 49.
    Eaton JE, Dzyubak B, Venkatesh SK, et al. (2016) Performance of magnetic resonance elastography in primary sclerosing cholangitis. J Gastroenterol Hepatol 31(6):1184–1190.  https://doi.org/10.1111/jgh.13263 CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Radiology, Mayo Clinic College of MedicineMayo ClinicRochesterUSA

Personalised recommendations