Morphologic features of hepatic injury in cardiac disease and shock

One-hundred-forty postmortem liver specimens from patients with cardiac disease or pre-terminal hypotensive shock were examined in order to characterize the histopathologic features of ischemic and congestive hepatic disease. The study group included patients with arteriosclerotic, valvular or hypertensive heart disease, primary pulmonary disease with cor pulmonale, myocarditis, cardiomyopathy, and shock. The hepatic lesions included centrilobular congestion alone (10%), congestion with necrosis (77%), centrilobular necrosis with inflammatory reaction (neutrophil or mononuclear cell) (27%), cardiac sclerosis (48%) and regenerative hyperplasia (23%). Cardiac sclerosis, the most common form of hepatic fibrosis seen, consisted of eccentric thickening or occlusion of the walls of central veins and perivenular scars extending into the lobular parenchyma. Regeneration of liver cells was manifested by either liver-cell plate thickening within a retained cord-like framework or by nodular masses of hepatocytes (nodular regenerative hyperplasia). Only one case of developing cirrhosis was identified in this series. The morphologic features outlined in this study should provide a useful basis for the classification of liver injury in cardiac disease and shock.