Venous Congestion

VENOUS CONGESTION
(Passive Hyperaemia)
Figure 1.0. Illustration of normal vein and varicose vein
Normal Structure: Abnormal Structure:

• Straight / tubular5 • Twisted
• Correctly-functioning valve • Presence of bulges
• Damaged valve
What is Venous
Congestion?
- the dilatation of veins and
capillaries due to impaired venous
drainage.
- overfilling and distention of the
veins with blood as a result of
mechanical obstruction or right
ventricular failure.
Etiology:
• Heart failure
• mitral stenosis, a type of heart
disease
• a blockage in a blood vessel
• a kink in a vein
• Pneumonia
• Thrombosis
• Inability of heart to pump blood
effectively
Congestion can be:
• Acute
- short duration but typically severe
• Chronic (CVC)
- persisting for a long time or constantly recurring
Accordingly, it is of two types:

• Local Venous Congestion
- results from obstruction to the venous outflow
from an organ or part of the body
• Systemic Venous Congestion
- engorgement of systemic veins
Morphology of the
Chronic Venous
Congestion (CVC)
of Organs
Figure 2.0. Schematic representation of mechanisms involved in chronic venous congestion (CVC)
CVC Lung
Figure 3.0. CVC lung. The alveolar septa are widened and thickened due to congestion,
oedema and mild fibrosis. The alveolar lumina contain heart failure cells (alveolar
macrophages containing haemosiderin pigment).
- Chronic venous congestion of the lung occurs in left heart

failure, especially in rheumatic mitral stenosis so that there
is consequent rise in pulmonary venous pressure.
Main cause: Left-sided heart failure, e.g. mitral stenosis
Normal Alveolar septa Thickened Alveolar septa
CVC Liver
Figure 4.0 Nutmeg liver. The cut surface shows mottled appearance—alternate pattern of
dark congestion and pale fatty change.
The liver is enlarged and tender and the capsule is tense.

Cut surface shows characteristic nutmeg appearance due
to red and yellow mottled appearance, corresponding to
congested centre of lobules and fatty peripheral zone
respectively.
Figure 4.1 CVC liver. The centrilobular zone shows marked degeneration and necrosis of
hepatocytes accompanied by haemorrhage while the peripheral zone shows mild fatty
change of liver cells.
Microscopically, the features show:

• Severe hypoxia
• Distended central veins and adjacent sinusoids
• Centrilobular haemorrhagic necrosis
• Fine centrilobular fibrosis and regeneration of hepatocytes
• Peripheral zone of the lobule less severely affected by
chronic hypoxia
• Fatty change in the hepatocytes
Causes:
Right-sided heart failure

• cardiomyopathy
• tricuspid regurgitation
• constrictive pericarditis
• cor pulmonale
CVC Spleen
Chronic venous congestion of
the spleen occurs in right heart
failure and in portal hypertension
from cirrhosis of liver.
Grossly, the spleen in early
stage is slightly to moderately
enlarged (up to 250 g as
compared to normal 150 g),
while in long-standing cases
there is progressive enlargement
and may weigh up to 500 to 1000
Figure 5.0 CVC spleen (Congestive
g. The organ is deeply congested, splenomegaly). Sectioned surface
tense and cyanotic. Sectioned shows that the spleen is heavy and
surface is grey-tan (Fig. 3.1). enlarged in size. The colour of
sectioned surface is grey-tan.
Figure 5.1 CVC spleen. The sinuses are dilated and congested. There is increased
fibrosis in the red pulp, capsule and the trabeculae. Gamna-Gandy body is also
seen.
Microscopically, the features show:

i) Enlarged red pulp
ii) Hyperplasia of reticuloendothelial cells
iii) Fibrous thickening
iv) Gamna-Gandy bodies
v) Congestive splenomegaly
CVC Kidney
Figure 6.0 shows marked congestion of the glomerular capillary loops, peritubular
capillaries and arterioles, along with margination of neutrophils
Grossly, the kidneys are slightly enlarged and the medulla is

congested.
Microscopically, the changes are rather mild. The tubules
may show degenerative changes like cloudy swelling and fatty
change. The glomeruli may show mesangial proliferation.
Causes: low cardiac output (forward failure), tubuloglomerular
feedback, increased intra-abdominal pressure or increased venous
pressure
References
Mohan, H. (2010). Textbook of Pathology, sixth edition. Jaypee

Brothers Medical Publishers
https://www.medicalnewstoday.com/articles/
319416#preventionhttps://www.medicalnewstoday.com/articles/
319416#prevention
https://www.britannica.com/science/lung-congestion
https://www.msdmanuals.com/en-gb/professional/hepatic-and-
biliary-disorders/vascular-disorders-of-the-liver/congestive-
hepatopathy
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4720202/
#:~:text=Kidney%20congestion%20in%20heart%20failure,and
%20mortality%20in%20heart%20failure.
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VENOUS CONGESTION

Normal Structure: Abnormal Structure:

Accordingly, it is of two types:

- Chronic venous congestion of the lung occurs in left heart

The liver is enlarged and tender and the capsule is tense.

Microscopically, the features show:

Right-sided heart failure

Microscopically, the features show:

Grossly, the kidneys are slightly enlarged and the medulla is

Mohan, H. (2010). Textbook of Pathology, sixth edition. Jaypee

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