Passive Hepatic Congestion – A forgotten cause of abnormal liver function tests?

Jamie Wild, Sheffield Teaching Hospitals

Ultrasound practitioners are often faced with requests where the clinician is trying to determine the cause of abnormal liver function tests (LFTs). The most common pathology encountered in practice which can result in abnormal LFTs is that of fatty liver disease relating to either alcohol use or non-alcoholic fatty liver disease (NAFLD) (Malakouti et al., 2017). Ultrasound has been shown to demonstrate a good sensitivity and specificity (84.8% and 93.6%) in the diagnosis of fatty liver disease (Hernaez et al., 2011). Given the prevalence of fatty liver disease in the population and ultrasound’s ability to diagnose fatty infiltration relatively easily, it is vital that ultrasound practitioners do not become complacent, and that other pathological processes are considered, especially when no clear cause for the abnormal LFTs is initially identified during the ultrasound examination.

While there are a host of other causes of abnormal LFTs, passive hepatic congestion (PHC) is one cause of abnormal LFTs which can be overlooked in the pursuit for the more obvious and common fatty liver. PHC may be asymptomatic for a prolonged period of time, with the only clue to suspect its presence being abnormalities in the LFTs (Fortea et al., 2020). If not recognised, chronic congestion leads to hepatic injury, eventually resulting in fibrosis and cirrhosis (Hilscher and Sanchez, 2016). As with any pathology, proper understanding and recognition of the clinical presentation and imaging features are vital to a conclusive diagnosis.

The poster aims to highlight a differential diagnosis for abnormal LFTs and provide information relating to the aetiology, pathophysiology and ultrasound features of PHC so that ultrasound practitioners are better equipped to recognise the pathology and be confident in their diagnosis, which can impact on the follow-up and treatment of a patient.

View poster