Nutmeg Liver

Nutmeg liver refers to the heterogeneous perfusion of the liver, usually as a result of hepatic venous congestion. Hepatic venous congestion prevents contrast-enhanced blood from diffusing through the liver, resulting in a mottled pattern of enhancement in the arterial and early portal venous phases. There is decreased enhancement of the liver peripherally due to due to decreased portal flow, hepatic congestion, and rarely infarction. The hepatic veins are also not well visualized. Delayed phases reveal a more uniform pattern of enhancement.

Hepatic venous congestion may be caused by hepatic venoocclusive disease, Budd-Chiari syndrome, right heart failure, or constrictive pericarditis. In Budd-Chiari syndrome the caudate lobe enhances normally due to its direct drainage into the inferior vena cava.

References

Reuther WL 3rd, Newman CA, Smith RE, Plavsic BM. Gastrointestinal case of the day. Primary leiomyosarcoma of the IVC with Budd-Chiari syndrome. Radiographics. 1999 Jan-Feb;19(1):248-51.