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Chylous ascites should suggest constrictive pericarditis even in a patient with cirrhosis

A T Williams1, R P Schneider

  • 1Department of Medicine, Vanderbilt University, School of Medicine, Nashville, Tennessee.

Journal of Clinical Gastroenterology
|October 1, 1990
PubMed

Insights

Chylous ascites, typically from malignancy, can occur in cirrhosis due to elevated central venous pressure. This case highlights constrictive pericarditis as a cause, necessitating prompt evaluation in cirrhotic patients.

Area of Science:

  • Cardiology
  • Gastroenterology
  • Internal Medicine

Background:

  • Chylous ascites is characterized by milky, triglyceride-rich fluid, commonly linked to lymphatic obstruction by malignancy.
  • Cirrhosis often presents with portal hypertension, a condition associated with increased abdominal fluid accumulation.

Observation:

  • A patient with cirrhosis developed constrictive pericarditis, leading to chylous ascites.
  • This clinical presentation suggests an unusual etiology for chylous ascites in the context of liver disease.

Findings:

  • The formation of chylous ascites was attributed to long-standing portal hypertension combined with elevated central venous pressure.
  • Constrictive pericarditis was identified as the underlying cause of the elevated central venous pressure.

Implications:

  • Chylous ascites in cirrhotic patients necessitates a thorough investigation for conditions that elevate central venous pressure, such as constrictive pericarditis.
  • This case broadens the differential diagnosis for chylous ascites, emphasizing the importance of considering cardiac causes in liver disease patients.

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