Nutmeg liver

Last revised by Dr Jeremy Jones on 20 Sep 2021

A nutmeg liver appearance is due to a perfusion abnormality of the liver usually as result of hepatic venous congestion. When 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 phases with decreased enhancement of the liver periphery. The areas of decreased enhancement represent decreased portal flow, hepatic congestion and ischemia. On delayed images parenchymal enhancement becomes more uniform. 

Conditions associated with hepatic venous congestion include:

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