Deer Horn Sign in Congestive Hepatopathy Due to Heart Failure

<b>Background and Clinical Significance:</b> The deer horn sign is an ultrasonographic (US) finding suggesting congestive hepatopathy. It is composed of dilated intrahepatic inferior vena cava (IVC) representing the deer's head and dilated hepatic veins (HVs) representing its horns. <b>Case Presentation:</b> A 72-year-old female patient presented with a one-week history of dull pain in the right upper abdominal quadrant. Her medical records showed that she had previously experienced cardiovascular problems; however, she is without any recent heart failure symptoms. The transabdominal US demonstrated the deer horn sign and hemodynamic changes in the hepatic venous drainage, which is suggestive of congestive hepatopathy. An echocardiogram revealed congestive heart failure with a preserved ejection fraction, mild-to-moderate mitral and tricuspid valve insufficiency, and severe aortic valve stenosis with mild aortic valve insufficiency. <b>Conclusions:</b> The definite diagnosis of heart failure is based on clinical and laboratory features; however, this sign may be helpful for diagnosis in emergency settings.