What is the classic appearance of the liver associated with chronic passive congestion due to right heart failure?

The classic appearance of the liver associated with chronic passive congestion due to right heart failure is referred to as a "nutmeg appearance." This distinctive pattern arises from the impaired venous outflow from the liver, leading to a combination of increased blood volume in the liver and areas of ischemia or necrosis.

In cases of right heart failure, the heart's inability to pump blood effectively results in pressure buildup in the venous system, specifically affecting the hepatic veins. This leads to engorgement of the hepatic sinusoids, resulting in a characteristic mottled appearance reminiscent of a nutmeg seed, with areas of congestion alternating with paler zones of necrotic tissue. The congestion is typically most prominent around the central veins, whereas the periportal areas might remain relatively unaffected.

This nutmeg pattern is a classic sign of chronic passive hepatic congestion and is not seen with other liver conditions such as fatty liver or cirrhosis, which have different underlying mechanisms and histological features. Understanding this pathophysiological process is crucial for recognizing the effects of right heart failure on liver morphology.