Congestive hepatopathy (CH) refers to hepatic abnormalities that result from passive hepatic venous congestion which when prolonged lead to fibrosis and cirrhosis. Liver dysfunction and corresponding clinical signs and symptoms typically manifest late in the disease process. Recognition of CH at imaging is critical because advanced liver fibrosis may develop before the condition is suspected clinically. We report a case of congestive hepatopathy in a 25– year old male presenting clinically with symptoms simulating Budd Chiari syndrome