Case 186: Hepatic Congestion

Diagnostic Category:

Clinical Presentation:

85 year old man with severe dilated cardiomyopathy.

CT: Retrograde contrast flow mimicking mosaic perfusion pattern

Imaging Findings:

Single phase CT reveals retrograde enhancement of liver parenchyma due to reflux of contrast into the hepatic veins. Retrograde contrast in the vein is mimicking hypervascular lesions and mosaic perfusion pattern, which is a typical sign for hepatic congestion, but not present in this case. Note that the contrast is denser in the upper IVC than in the aorta. The heart is enlarged, and the right atrium and IVC are dilated.