Abstract
One hundred twenty autopied cases (28 children and 92 adults) with congestive liver were classified histopathologically into four grades by following criteria for hepatic lesions.
Grade I : Congestion and atrophy in hepatic lobules.
Grade II : Degeneration, necrosis and focal or centroportal fibrosis in hepatic lobules.
Grade III : Congestive liver fibrosis; formation of reversed lobules due to centrocentral fibrosis among hepatic lobules.
Grade IV : Congestive liver cirrhosis : formation of pseudolobules due to centroportal and centrocentral fibrosis between hepatic lobules.
The morphogenesis and morphological characteristics of hepatic lesions due to acute or chronic congestive heart failure were studied in detail. In addition, intimal thickening of the blood vessels (inferior vena cava, hepatic vein, portal vein and hepatic artery), weight of the organs (liver and spleen) and volume of ascites corresponding to each grade of congestive liver were also investigated. Marked development of hepatic lesions and intimal thickening of posthepatic veins were observed in adult cases with severe congestive heart failure. The results were as follows.1) In child cases, the incidences of congestive liver in grades I and II were 17.9% and 82.1%, respectively. In adult cases, the incidences of congestive liver in grades I, II, III and IV were 13.0%, 72.8%, 10.9% and 3.3%, respectively. In all of child cases and the majority of adult cases, grades I and II were prominent.
2) Valvular disease, coronary heart disease and hypertensive heart disease in adult cases were original diseases of congestive liver fibrosis and cirrhosis.
3) Grade of congestive liver was relative to degrees and periods of heart failure in adult cases. Repeated heart failure was more important than continuous heart failure for genesis of congestive liver cirrhosis.
4) The liver weight was within normal limits in any grade of congestive liver in child and adult cases.
5) Intimal thickening of the blood vessels due to congestive heart failure was observed in posthepatic veins (IVC and HV) of adult cases. Phlebosclerosis of posthepatic veins was relative to degrees and periods of heart failure and had good relation to grades of congestive liver.
6) The spleen weight and ascites increased slightly with grades of congestive liver in adult cases. The portal hypertension due to congestive heart failure was suggested in congestive liver fibrosis and cirrhosis.
