IPLab:Lab 4:Chronic Passive Congestion

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Clinical Summary

This 57-year-old male was hospitalized with a three-month history of a dry, hacking cough, dyspnea, and chest pain. He was diagnosed as having congestive heart failure due to viral myocarditisViral myocarditis is an inflammatory viral infection of the myocardium.. There was no evidence of myocardial infarctionMyocardial infarction is necrosis of myocardial tissue which occurs as a result of a deprivation of blood supply, and thus oxygen, to the heart tissue. Blockage of blood supply to the myocardium is caused by occlusion of a coronary artery., but renal and hepatic functions were decreased. The patient developed refractory congestive heart failure and renal failureRenal failure is the severe reduction of renal function and often leads to reduced urinary output.. The patient's cardiac indexCardiac index is a measure of a patient's cardiac output in relation to body size. was marginal and he was classified as a having congestive cardiomyopathy. The patient had a cardiorespiratory arrest and died two months after admission.

Autopsy Findings

At autopsy the lungs were congested and edematous with evidence of lobar pneumoniaIn alcoholics, aspiration pneumonia is common--bacteria enter the lung via aspiration of gastric contents.. The heart weighed 540 gramsA normal heart weighs 300 grams (range: 270 to 360 grams). and showed 75 to 95% atherosclerotic stenosis of all the major coronary arteries. The right and left ventricles were markedly dilated. The ventricular walls were extremely thin with patchy areas of subendocardial fibrosis. The liver weighed 1630 gramsA normal liver weighs 1650 grams (range: 1500 to 1800 grams). and displayed the classic "nutmeg appearance" of chronic passive hepatic congestionChronic passive hepatic congestion is a disorder seen in conjunction with right-sided heart failure. In right-sided heart failure, peripheral venous pressures increase and thus reduce outflow from the liver. The result is a chronically congested liver. on cut surface.


Virtual Microscopy

Liver Chronic Passive Congestion

Normal Liver

Study Questions

Additional Resources


Journal Articles


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