Congestive hepatopathy includes a spectrum of hepatic derangements that occur in the settings of Right heart failure. If there is subsequent hepatic fibrosis the term cardiac cirrhosis may be used. The timely diagnosis of a cardiac etiology of liver dysfunction is important because such dysfunction is potentially reversible if the underlying cardiac disease is treated before the development of frank cirrhosis. Below, we present a case of 18 years old adolescent girl who was incidentally found to have Atrial Septal defect. Abdominal USG revealed Nutmeg Liver. In this case report the literature will be discussed on cardiac events resulting in Nut Meg liver and its management. Introduction: Congestive hepatopathy is also known as Nutmeg liver and chronic passive congestion of the liver, which is an liver dysfunction due to venous congestion, usually caused by congestive heart failure, The gross pathological appearance of a liver with Nutmeg is Speckled like a grated nut meg kernel [6]. Treatment is directed to remove the cause. So, therapy aimed at improving Right heart function. True nutmeg liver is usually second to left sided heart failure causing congestive right heart failure and the treatment options are limited [12]. Case Report: A 18 years old adolescent girl with a known atrial septal defect, cystichygroma in the left neck, presented to the cardiology department complaining of shortness of breath (grade IV), non productive cough, orthopnea, fatigue. On physical examination the findings were Tachypnea, cold extremities and bibasilar crackles on pulmonary auscultation; An abdominal ultra sound was requested and the findings were congestive hepatopathy, splenomegaly minimal left pleural effusion and moderate volume of ascities. X-ray showed cardiomegaly obliterating left CP angle, patchy air space opacities, right mid zone and lower zone pulmonary edema changes. 2D Echo cardiogram showed cyanotic heart disease, Large oss with atrial septal defect with predominantly left to right shunt, dilated right atria, right ventricle& pulmonary artery; severe tricuspid regurgitation with moderate pulmonary artery hypertension, Right ventricular dysfunction with moderate atrial regurgitation; mild pulmonary edema, global hypokinesia of left ventricle, mild left ventricle systolic dysfunction. Conclusion: The study highlight cardiac cause should be thought for differential diagnosis when patient presents with liver cirrhosis; the incidence of patients with Nutmeg liver are presenting in general practice. 

Keywords: Congestive Hepatopathy; Right Heat Failure; Atrial Septal Defect; Nut Meg Liver; Congestive Heart Failure; Liver Dysfunction; Cirrhosis of Liver.