Chronic Venous Congestion Of
Lung, Liver and Spleen
INTRODUCTION
Congestion is a hemodynamic i.e. circulatory
disorder.
Definition: Congestion is a passive process resulting
...
TYPES OF CVC
Local Systemic
 Results from
obstruction to
venous outflow
from an organ or
part of the body.
 Eg: Portal v...
CONSEQUENCES
 As a result of increased volumes and
pressures, congestion commonly leads to
edema.
 In passive long stand...
GROSS APPEARANCE
 Congested tissue is dusky
reddish blue in color due to red
cell stasis and accumulation of
deoxygenated...
Mechanisms involved in
CVC of different organs :Heart
Failure
Right-sided failure Left Sided failure
Pressure transmitted ...
CVC OF LUNG
 CAUSE:
 Left Heart Failure, especially in
rheumatoid mitral stenosis so that there is
consequent venous pre...
Brown induration
Of lung seen in cut
section
HISTOLOGY OF CVC LUNG
 Alveolar septa are widened due to interstitial
edema as well as due to dilated and congested
capil...
CVC OF LIVER
 CAUSE:
 Occurs mainly due to right heart failure and
sometimes due to occlusion of Inferior
Venacava and H...
Gross appearance of CVC
Liver
1)Nut -meg appearance
2)Peripheral fatty change
NUT-MEG LIVER
HISTOLOGY OF CVC LIVER
 Changes are more marked in the
centrilobular zone due to severe hypoxia
than in the periphery.
 ...
CVC OF SPLEEN
 CAUSES:
 Can occur due to right heart failure and in
portal hypertension from liver cirrhosis.
 GROSS AP...
Gross appearance
Of CVC spleen
1)Deeply congested
with tense capsule
2)Cut surface shows gray
tan parenchyma
HISTOLOGY OF CVC SPLEEN
 Red pulp is enlarged due to congestion
and marked sinusoidal dilation and there
are many areas o...
 There is fibrous thickening of the capsule
and the trabeculae.
 Some of the hemorrhages overlying
fibrous tissue get de...
Cvcofliverandspleen 140720222447-phpapp02
Cvcofliverandspleen 140720222447-phpapp02
Cvcofliverandspleen 140720222447-phpapp02
Cvcofliverandspleen 140720222447-phpapp02
Cvcofliverandspleen 140720222447-phpapp02
Cvcofliverandspleen 140720222447-phpapp02
Cvcofliverandspleen 140720222447-phpapp02
Cvcofliverandspleen 140720222447-phpapp02
Cvcofliverandspleen 140720222447-phpapp02
Cvcofliverandspleen 140720222447-phpapp02
Cvcofliverandspleen 140720222447-phpapp02
Cvcofliverandspleen 140720222447-phpapp02
Cvcofliverandspleen 140720222447-phpapp02
Cvcofliverandspleen 140720222447-phpapp02
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  1. 1. Chronic Venous Congestion Of Lung, Liver and Spleen
  2. 2. INTRODUCTION Congestion is a hemodynamic i.e. circulatory disorder. Definition: Congestion is a passive process resulting from reduced outflow of blood from a tissue. It is also called passive hyperemia . It can be: 1)Systemic or Local And 2)Acute or chronic Chronic is more common so it is known as Chronic Venous congestion(CVC).
  3. 3. TYPES OF CVC Local Systemic  Results from obstruction to venous outflow from an organ or part of the body.  Eg: Portal venous obstruction in liver cirrhosis, plasters, tumors, pregnancy and hernia.  This occurs mainly due to engorgement of systemic veins.  Eg: In right and left sided heart failure and diseases of lungs interfering pulmonary blood flow like emphysema and fibrosis.
  4. 4. CONSEQUENCES  As a result of increased volumes and pressures, congestion commonly leads to edema.  In passive long standing congestion, lack of blood flow causes chronic hypoxia potentially resulting in ischemic tissue injury and scarring.  Capillary rupture in chronic congestion can also cause small hemorrhagic foci, subsequent catabolism of extravasated red cells can leave residual tell tale clusters of hemosiderin laden macrophages.
  5. 5. GROSS APPEARANCE  Congested tissue is dusky reddish blue in color due to red cell stasis and accumulation of deoxygenated hemoglobin.
  6. 6. Mechanisms involved in CVC of different organs :Heart Failure Right-sided failure Left Sided failure Pressure transmitted upstream of right heart Pressure transmitted upstream of le Systemic Venous Congestion Pulmonary congestion CVC of lung CVC liver CVC spleen CVC kidney Congested Leg Veins
  7. 7. CVC OF LUNG  CAUSE:  Left Heart Failure, especially in rheumatoid mitral stenosis so that there is consequent venous pressure. GROSS APPEARANCE:  Lungs are heavy and firm in consistency.  Sectioned surface is rusty brown in color due to which is referred to as “brown induration” of lungs.
  8. 8. Brown induration Of lung seen in cut section
  9. 9. HISTOLOGY OF CVC LUNG  Alveolar septa are widened due to interstitial edema as well as due to dilated and congested capillaries.  Septa mildly thickened due to slight increase in fibrous connective tissue.  Minute intra-alveolar hemorrhages can be seen due to rupture of dilated and congested capillaries. The breakdown of erythrocytes liberates hemosiderin pigment which is taken up by alveolar macrophages.
  10. 10. CVC OF LIVER  CAUSE:  Occurs mainly due to right heart failure and sometimes due to occlusion of Inferior Venacava and Hepatic Vein . GROSS APPEARANCE:  The liver is enlarged and the capsule is tense.  Cut surface shows characteristic red and yellow mottled appearance mainly due to congested centre of lobules and fatty peripheral zone respectively.
  11. 11. Gross appearance of CVC Liver 1)Nut -meg appearance 2)Peripheral fatty change
  12. 12. NUT-MEG LIVER
  13. 13. HISTOLOGY OF CVC LIVER  Changes are more marked in the centrilobular zone due to severe hypoxia than in the periphery.  Central vein as well as adjacent sinusoids are distended and filled with blood.  The centrilobular hepatocytes undergo degenerative changes , and eventually “centrilobular hemorrhagic necrosis” can be seen.  Long standing cases may show fine centrilobular fibrosis and regeneration of hepatocytes.  The peripheral zone of the lobule is less severely affected by chronic hypoxia and shows some fatty change in the hepatocytes.
  14. 14. CVC OF SPLEEN  CAUSES:  Can occur due to right heart failure and in portal hypertension from liver cirrhosis.  GROSS APPEARANCE:  Spleen in early stage is moderately enlarged(up to 250g as compared to normal 150g.)  In long standing cases there is progressive enlargement and may weigh up to 500 to 1000g.  Organ is deeply congested, tense and cyanotic.  Sectioned surface is gray tan.
  15. 15. Gross appearance Of CVC spleen 1)Deeply congested with tense capsule
  16. 16. 2)Cut surface shows gray tan parenchyma
  17. 17. HISTOLOGY OF CVC SPLEEN  Red pulp is enlarged due to congestion and marked sinusoidal dilation and there are many areas of new and old hemorrhages.  Sinusoids may get converted to capillary (capillarisation of sinusoids).  There is hyperplasia of reticuloendothelial cells in the red pulp of the spleen( Splenic macrophages).
  18. 18.  There is fibrous thickening of the capsule and the trabeculae.  Some of the hemorrhages overlying fibrous tissue get deposits of the hemosiderin pigment and the calcium salts, these organized structures are called Gamna Gandy bodies or siderofibrotic nodules.  Firmness of spleen in advanced stage is seen more commonly in hepatic cirrhosis(Congestive splenomegaly) and is the most common cause of hypersplenism.

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