Right Atrial Collapse With Hepatic Hydrothorax in Advanced Liver Disease

Area of Science:

• Cardiology
• Emergency Medicine
• Medical Imaging

Background:

• Cardiac chamber collapse is typically caused by intrinsic cardiac issues.
• Extrapericardial causes are uncommon but can mimic primary cardiac conditions.
• Focused cardiac ultrasound (FoCUS) is a valuable tool in emergency settings for undiagnosed cardiopulmonary symptoms.

Observation:

• A patient with newly diagnosed cirrhosis presented with massive ascites and large pleural effusions.
• These conditions significantly distorted the patient's cardiac anatomy and venous return.
• The patient experienced dyspnea and hypotension, indicating severe cardiopulmonary compromise.

Findings:

• FoCUS revealed cardiac chamber collapse secondary to the external compression from ascites and pleural effusions.
• The ultrasound findings were crucial in differentiating the cause of the patient's critical condition.
• This diagnosis guided the subsequent therapeutic interventions.

Implications:

• FoCUS can be essential for diagnosing rare causes of cardiac dysfunction in critically ill patients.
• Prompt identification of extrapericardial compression is vital for appropriate management.
• This case highlights the utility of point-of-care ultrasound in complex presentations.