Constrictive Pericarditis as a Cause of Refractory Ascites

Area of Science:

• Gastroenterology
• Cardiology
• Internal Medicine

Background:

• Ascites, varices, and hepatosplenomegaly are common presenting symptoms in patients with liver disease.
• Initial diagnostic workup often focuses on hepatic causes, potentially delaying diagnosis of other underlying conditions.

Observation:

• A 43-year-old male presented with ascites, varices, and hepatosplenomegaly.
• Initial laboratory findings included normal platelets, mild liver dysfunction, and elevated alkaline phosphatase.
• Liver biopsy revealed sinusoidal dilation but not cirrhosis.

Findings:

• Ascitic fluid analysis suggested a cardiac origin.
• Subsequent cardiac evaluation confirmed constrictive pericarditis as the cause of the patient's symptoms.

Implications:

• This case underscores the necessity of a comprehensive differential diagnosis when evaluating ascites.
• Considering non-hepatic etiologies, such as cardiac conditions, is crucial for accurate diagnosis and effective treatment.
• Highlights the importance of integrated diagnostic approaches in complex presentations.