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Compression, atrophy, and necrosis of the centrilobular hepatocytes occur and fatty infiltration may ensue. In chronic cases, fibrosis may develop in the centrilobular regions resulting in cardiac cirrhosis, which plump granny has the classic nutmeg appearance on gross examination.3 In passive venous congestion, CT will depict the enlarged IVC and hepatic veins since the failing right atrium cannot accommodate the returning blood. Actually, intravenous contrast administered in the upper body may reflux into the IVC and hepatic plump granny veins. As in this case, the liver parenchyma will show an inhomogeneous, mottled, plump granny reticulated, or mosaic pattern of enhancement. Linear and curvilinear regions of poor enhancement may be due to delayed enhancement in regions of small- and medium-sized hepatic veins.
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