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 |
Specialty: Gastroenterology, Cardiology
ICD-10: ,