Chronic Venous Congestion Of
Lung, Liver and Spleen
Congestion is a hemodynamic i.e. circulatory
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 is more common so it is known as Chronic
TYPES OF CVC
from an organ or
part of the body.
Eg: Portal venous
obstruction in liver
This occurs mainly due
to engorgement of
Eg: In right and left
sided heart failure
and diseases of lungs
blood flow like
As a result of increased volumes and
pressures, congestion commonly leads to
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.
Congested tissue is dusky
reddish blue in color due to red
cell stasis and accumulation of
Mechanisms involved in
CVC of different organs :Heart
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
CVC OF LUNG
Left Heart Failure, especially in
rheumatoid mitral stenosis so that there is
consequent venous pressure.
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.
HISTOLOGY OF CVC LUNG
Alveolar septa are widened due to interstitial
edema as well as due to dilated and congested
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
The breakdown of erythrocytes liberates
hemosiderin pigment which is taken up by
CVC OF LIVER
Occurs mainly due to right heart failure and
sometimes due to occlusion of Inferior
Venacava and Hepatic Vein .
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.
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
Long standing cases may show fine
centrilobular fibrosis and regeneration of
The peripheral zone of the lobule is less
severely affected by chronic hypoxia and
shows some fatty change in the
CVC OF SPLEEN
Can occur due to right heart failure and in
portal hypertension from liver cirrhosis.
Spleen in early stage is moderately
enlarged(up to 250g as compared to normal
In long standing cases there is progressive
enlargement and may weigh up to 500 to
Organ is deeply congested, tense and
Sectioned surface is gray tan.
Of CVC spleen
with tense capsule
HISTOLOGY OF CVC SPLEEN
Red pulp is enlarged due to congestion
and marked sinusoidal dilation and there
are many areas of new and old
Sinusoids may get converted to capillary
(capillarisation of sinusoids).
There is hyperplasia of
reticuloendothelial cells in the red pulp
of the spleen( Splenic macrophages).
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
Firmness of spleen in advanced stage is
seen more commonly in hepatic
cirrhosis(Congestive splenomegaly) and is
the most common cause of hypersplenism.