TIL: I actually learned this one last week, but forgot to share. Luck would have it that it came up again today and I learned a bit more.The image to the right shows a "nutmeg liver" next to a chunk of raw nutmeg. The problem with this attempt at descriptive naming is that, if you're like me (or anyone unfamiliar with spice preparation) you have no idea what unground nutmeg looks like. I only assume the nutmeg is in the upper left because, at this scale, if that were the liver then nutmeg is naturally the size of a small car.
Anyways, nutmeg liver is usually caused by chronic right ventricular heart failure. Left heart failure generally causes pulmonary edema (fluid in the lungs) because the heart is having a hard time pumping blood out to the body. When the right ventricle weakens, the heart is struggling to perfuse the lungs and blood piles up in the veins. Think of it like when the George Washington Bridge grinds to a halt: every town upstream of the affected side of the bridge gets traffic congestion, but the most affected region will be the closest town to the bridge. The liver is the Fort Lee of the venous system and when blood backs up it puts pressure on the tiny veins in the hepatic tissue. This slowly dilates the venules and small veins of the liver, creating the "nutmeg-esque" look.
If this process happened faster, the tissue would be likely to simply die, but the slow chronic build-up allows the liver to adapt. The process is theoretically reversible through the removal of the downstream blockage, but congestive heart failure isn't a simple problem to address, so this nutmeg-y omen is often a harbinger of bad things to come.
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