A distinctive perivenular hepatic lesion associated with heart failure.

Hepatic morphologic changes in seven patients in heart failure who were initially thought to have hepatitis are reported. In each instance, percutaneous liver biopsy or post mortem tissue examination disclosed a striking lesion involving all perivenular areas, with replacement of hepatocytes by erythrocytes. Four patients were in pure left-heart failure, while three were in biventricular failure. Upon treatment of the heart failure, the conditions of all patients improved clinically, and liver-function tests returned to normal or near normal. In two patients who later had refractory heart failure and died, there was no evidence of hepatic-vein thrombosis or occlusion post-mortem. A hypothesis is offered for the pathogenesis of this lesion, and its clinico-pathologic differential is discussed.