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The Spectrum of Histologic Findings in Hepatic Outflow Obstruction
Raul S Gonzalez, Michael A Gilger, Won Jae Huh
1From the Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, New York (Dr Gonzalez); and the Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee (Drs Gilger, Huh, and Washington). Dr Gilger is currently at Colorado GI Pathology/Centennial Pathologists, Centennial.
Insights
Histologic findings can help differentiate cardiac hepatopathy from Budd-Chiari syndrome. Pericellular/sinusoidal fibrosis suggests cardiac hepatopathy, while centrilobular necrosis indicates Budd-Chiari syndrome.
Area of Science:
- Hepatology
- Pathology
- Vascular Medicine
Background:
- Cardiac hepatopathy and Budd-Chiari syndrome are hepatic venous outflow obstructions.
- Both conditions share overlapping histologic findings like sinusoidal dilation and centrilobular necrosis.
- Distinguishing between them is crucial due to different underlying pathophysiology.
Purpose of the Study:
- To identify specific morphologic findings that differentiate cardiac hepatopathy from Budd-Chiari syndrome.
- To aid in diagnosing previously unrecognized cases of these conditions.
Main Methods:
- Retrospective analysis of 26 cardiac hepatopathy and 23 Budd-Chiari syndrome liver biopsy specimens.
- Evaluation of hematoxylin and eosin and trichrome stained slides for distinctive histologic features.
Main Results:
- Sinusoidal dilation and portal tract changes (fibrosis, inflammation, bile ductular reaction) were common in both.
- Pericellular/sinusoidal fibrosis and central vein fibrosis were significantly more frequent in cardiac hepatopathy.
- Centrilobular hepatocyte dropout/necrosis was more common in Budd-Chiari syndrome.
Conclusions:
- Pericellular/sinusoidal fibrosis is a key differentiator, suggesting cardiac hepatopathy, especially in chronic cases.
- Portal tract changes are not exclusive and should not preclude diagnosing hepatic outflow obstruction.
- Specific fibrosis patterns can guide diagnosis in patients lacking prior clinical information.
Context:
-Cardiac hepatopathy and Budd-Chiari syndrome are 2 forms of hepatic venous outflow obstruction with different pathophysiology but overlapping histologic findings, including sinusoidal dilation and centrilobular necrosis.
Objective:
-To determine whether a constellation of morphologic findings could help distinguish between the 2 and could suggest the diagnoses in previously undiagnosed patients.
Design:
-We identified 26 specimens with a diagnosis of cardiac hepatopathy and 23 with a diagnosis of Budd-Chiari syndrome. Slides stained with hematoxylin and eosin and with trichrome were evaluated for several distinctive histologic findings.
Results:
-Features common to both forms of hepatic outflow obstruction included sinusoidal dilation and portal tract changes of fibrosis, chronic inflammation, and bile ductular reaction. Histologic findings significantly more common in cardiac hepatopathy included pericellular/sinusoidal fibrosis and fibrosis around the central vein. Only centrilobular hepatocyte dropout/necrosis was significantly more common in Budd-Chiari, regardless of duration.
Conclusions:
-The finding of pericellular/sinusoidal fibrosis in cardiac hepatopathy compared with Budd-Chiari is not unexpected, given the chronic nature of most cardiac hepatopathy. Portal tract changes are common in both forms of hepatic outflow obstruction and should not deter one from making the diagnosis of hepatic outflow obstruction. Fibrosis along sinusoids and around the central vein may be suggestive of cardiac hepatopathy in biopsies from patients without a prior diagnosis.
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