Internal Medicine

Congestive hepatopathy “Nutmeg liver”

Congestive hepatopathy, also known as nutmeg liver and chronic passive congestion of the liver, is liver dysfunction due to venous congestion, usually due to congestive heart failure.

The gross pathological appearance of a liver affected by chronic passive congestion is “speckled” like a grated nutmeg kernel; the dark spots represent the dilated and congested hepatic venules and small hepatic veins. The paler areas are unaffected surrounding liver tissue.

Clinical features

  • Sense of fullness and tenderness in the right hypochondriac region
  • Gastrointestinal catarrh
  • Vomiting of blood
  • Jaundice
    • Light or clay-colored stool
    • Bile coloured urine
  • Ascites, followed later by generalised oedema
    • Due to portal obstruction
  • Enlarged and tender liver


  • Severe and longstanding hepatic congestion,
    • Fibrosis (cardiac cirrhosis)



  • Electrocardiogram (EKG)
  • Diagnostic paracentesis


  • RUQ-USG + Doppler studies (of portal vein and hepatic veins & artery)
  • Echocardiograph (ECG)
  • CT-scan
    • Dilatation of the IVC and hepatic veins
    • Retrograde hepatic venous opacification shortly after IV contrast injection
    • Heterogeneous hepatic enhancement due to stagnant blood flow
CT appearance of liver in congestive hepatopathy, sometimes referred to as a nutmeg liver. Due to congestion, contrast does not flow through the liver in a normal manner. Axial and coronal images in the portal venous phase. | Hellerhoff – CC BY-SA 3.0,


  • Perisinusoidal fibrosis
  • Hepatic venule dilation
  • Dilation of the sinusoids in zone III (centrilobular)
Congestive hepathopathy is characterized by: Perisinusoidal fibrosis, Hepatic venule dilation, and Dilation of the sinusoids in zone III (centrilobular). | Nephron – CC BY-SA 3.0,


Treatment of underlying cause

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