Congestive hepatopathy: the role of the radiologist in the diagnosis

Congestive Hepatopathy

“…It provides important information regarding the morphology and vascularization of the liver as the Doppler mode can evaluate the direction and speed of the hepatic blood flow. Characteristic ultrasound findings include hepatomegaly, an irregular and nodular liver, dilation of inferior vena cava and hepatic veins with absence or attenuation of the normal variation of their diameter with respiratory movements, loss of normal triphasic hepatic venous waveform (under physiological conditions the hepatic veins present a predominantly anterograde flow with a triphasic wave pattern, in which four waves can be identified—“a”, “S”, “v” and “D”, each corresponding to a different phase of the cardiac cycle), and increase in the portal vein pulsatility index and in hepatic arterial resistance [ 73 , 74 ] ( Figure 2 B–D). Of note, the appearance of a nodular or heterogeneous liver on standard imaging is not sufficient to diagnosis cirrhosis in CH [ 15 ].…”

“…It is of great help to specify the clinical suspicion of CH in the radiological request since many of the findings are elusive. Importantly, none of them is specific to CH and, therefore, the diagnosis should also be supported by other extrahepatic findings such as cardiomegaly, hypertrophy of the right atrium and ventricle, thickening and calcification of the pericardium, pericardial effusion, or pleural effusion [73] (Figure 2A). Abdominal ultrasound is typically the first imaging modality used to evaluate patients with suspected liver disease.…”

Congestive Hepatopathy Diagnosed by Venous Excess Ultrasound Score

“…2 In addition, CH is a noninflammatory condition where early clinical signs are due to portal hypertension in the setting of preserved synthetic function, and therefore, the diagnostic tests are nonspecific and may not be abnormal until advanced disease. 1,6 Prompt diagnosis of CH is critical to guide early therapeutic management, prevent acute liver injury or failure, and mitigate the long-term risk of developing cirrhosis and hepatocellular carcinoma. 1 POCUS allows clinicians to systematically and objectively diagnose and grade the severity of venous congestion compared with physical examination.…”

Striking Elevations in Aminotransferases in a Case of Congestive Hepatopathy Without Concurrent Hypotension

“…Ultrasonography with Doppler studies of the right upper quadrant is warranted to rule out possible thrombosis and Budd-Chiari syndrome [ 7 ]. Characteristic ultrasound findings of congestive hepatopathy seen in the inferior vena cava and hepatic veins along with a detailed clinical history can also help confirm the diagnosis [ 11 ]. In patients with ascites, diagnostic paracentesis may aid in the diagnosis with the serum-to ascites albumin gradient being greater or equal to 1.1, demonstrating portal hypertension [ 12 ].…”