Nutmeg Liver

nutmeg liver ct

Nutmeg liver is a perfusion abnormality of the liver due to hepatic venous congestion. When the hepatic veins are congested, contrast is prevented from diffusing through the liver in a normal manner. This results in a mottled pattern of contrast enhancement in the arterial and early portal venous phase with decreased enhancement of the liver periphery. The areas of decreased enhancement are due to decreased portal flow, hepatic congestion and ischaemia. On delayed images enhancement of the liver becomes more uniform. Hepatic venous congestion may be caused by Budd-Chiari syndrome, right heart failure or constrictive pericarditis. In Budd-Chiari syndrome the caudate lobe enhances normally as it has a separate draining vein directly into the IVC.

References:
1. Reuther WL et al. Gastrointestinal Case of the Day, Radiographics. 1999;19:248-251
2. Dahnert W. Radiology Review Manual, 5th edition. Lippincott, Williams and Wilkins 2003

Credit: Dr Donna D'Souza