Chronic Venous Congestion of Liver and Spleen

Overview

• Topic: Chronic Venous Congestion (CVC) of Liver and Spleen
• Focus: Pathogenesis, gross, and microscopic features

Chronic Venous Congestion of Liver

Pathogenesis

• Cause: Right heart failure and the resulting increased pressure in the central vein
• Transmission: Pressure transmitted to hepatic sinusoids, leading to their dilatation
• Impact:
  • Centrilobular Zone: Pressure atrophy of hepatocytes
  • Mid Zone: Fatty change due to relative hypoxia
  • Periphery: Remains relatively normal

Long-standing CVC Liver

• Central Vein: Thickening and sinusoidal thrombosis
• Progression: Sinusoidal fibrosis, potentially leading to generalized fibrosis and cirrhosis
• Cardiac Cirrhosis: Cirrhosis caused by right-sided heart failure

Gross Features

• Appearance: Nutmeg liver (dark and pale spots representing congested and normal areas, respectively)

Microscopic Features

• Central Vein: Dilated and congested
• Central Hemorrhagic Necrosis: Mostly around the centrilobular zone
• Fatty Change: Notable in mid-zonal hepatocytes
• Peripheral Zone: Relatively normal

Chronic Venous Congestion of Spleen

Pathogenesis

• Cause:
  • Right heart failure
  • Portal hypertension
• Transmission: Increased pressure in portal vein to splenic vein, leading to congestion

Long-standing CVC Spleen

• Fibrosis: Diffuse splenic fibrosis, sometimes with fibrotic and calcified areas (Gamma-Gandy bodies)

Gross Features

• Spleen: Enlarged, firm, tense with thickened capsule
• Surface: Dark red ooze

Microscopic Features

• Capsule and Trabeculae: Thickened
• Red Pulp: Congested splenic sinusoids, old hemorrhage, and fibrosis
• Gamma-Gandy Bodies:
  • Small, firm, yellow-brown foci with dense fibrous tissue
  • Impregnated with iron pigment and calcium salts
  • Result from perivascular hemorrhages
  • Also seen in sickle cell anemia, hemochromatosis, and some cancers

Conclusion

• Chronic Venous Congestion impacts liver and spleen following similar pathological pathways due to systemic venous pressure from right heart failure.
• Recognizing gross and microscopic features is crucial for diagnosis and understanding the extent of organ damage.