Chronic passive congestion of the liver from right heart failure can result in a hepatopathy with parenchymal sclerosis. The hepatopathy usually reverses if the heart failure is corrected.


There is hepatomegaly and the liver is tender to palpation. In severe tricuspid valve disease the liver may be "pulsatile." On cross section the liver shows a "nutmeg " appearance due to congestion of the central zone and pallor in the peripheral zones.


Clinically the patient shows elevated liver function tests, often with a cholestatic pattern.


Histologic changes

(1) congestion in the central zone with sinusoidal dilatation

(2) compression of the hepatocellular plates

(3) hepatocytes show cytoplasmic lipofuscin and hyaline globules

(4) centrizonal hepatocellular necrosis may develop which is resolved by fibrosis


Cardiac sclerosis occurs when fibrosis around adjacent hepatic veins link up to form septae between separate veins and between central veins and portal tracts. This grossly may resemble cirrhosis but the hepatic architecture and function are preserved. In addition, portal hypertension is rare.


Rarely true cirrhosis may develop.


The hepatopathy needs to be distinguished from liver injury caused by alcohol, drugs, viruses, etc.


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