RADIOLOGY: HEPATOBILIARY: Case# 32848: HEPATIC CONGESTION SECONDARY TO HEART FAILURE. The patient is a 65 year old female with a history of diabetes mellitus and cardiac disease. There is hepatic congestion suggesting congestive heart failure. No focal hepatic lesions are seen. The liver is of low attenuation in appearance but also reflects fatty infiltration. There is a moderate amount of free intra-peritoneal fluid which surrounds the liver and extends into the peri-colonic gutter. CT findings of passive hepatic congestion include globally delayed enhancement; enhancement of portal veins, hepatic arteries, and the adjacent parenchyma; a reticulated mosaic pattern of enhancement; and, prominent IVC and hepatic vein enhancement due to contrast reflux from a dilated right atrium.