Description

Dai et al reported the Congestive Hepatic Fibrosis Score, which is a grading system for the severity of histologic fibrosis in a patient with passive hepatic congestion. This correlates with right atrial pressure. The authors are from the University of Washington in Seattle.


 

Patient selection: chronic right heart failure with passive hepatic congestion

 

Evolution: congestion to centrizonal necrosis to hepatic fibrosis to cirrhosis (cardiac sclerosis)

 

Evaluation: liver biopsy stained with trichrome and reticulin stains

 

Centrizonal Fibrosis

Portal Fibrosis

Cirrhosis

Score

absent

absent

absent

0

present

absent

absent

1

present

mild

absent

2A

present

moderate, no bridging

absent

2B

present

with bridging

absent

3

present

with bridging

present

4

 

where:

• Initial bridging in congestive hepatic fibrosis is centrizonal to porta.

• Cirrhosis requires regenerative nodules.

 

A patient with congestive hepatic fibrosis may also show sinusoidal dilatation.

Fibrosis Score

Right Atrial Pressure

normal

5 mm Hg

0

9 mm Hg

1

13 mm Hg

2A

17 mm Hg

2B or 3

20 mm Hg

 


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