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Heart Failure-Related Ascites With Low Serum-Ascites Albumin Gradient: Diagnostic Clues From Triphasic Abdominal

Angkawipa Trongtorsak1, Veraprapas Kittipibul2, Drashti Antala1

  • 1Internal Medicine, AMITA Health Saint Francis Hospital, Evanston, USA.

Cureus
|February 18, 2022
PubMed

Insights

Serum-ascites albumin gradient (SAAG) helps identify ascites causes. This case highlights rare low-SAAG ascites in heart failure, revealing portal hypertension as the origin, necessitating further investigation beyond typical high-SAAG heart failure indicators.

Area of Science:

  • Cardiology
  • Gastroenterology
  • Radiology

Background:

  • Serum-ascites albumin gradient (SAAG) is crucial for differentiating ascites etiologies.
  • High SAAG (>1.1 g/dL) typically indicates portal hypertension, commonly seen in heart failure.
  • Low SAAG ascites in heart failure is uncommon and warrants exclusion of other serious conditions like malignancy or infection.

Observation:

  • A 42-year-old female presented with ascites and worsening congestive heart failure.
  • Initial assessment revealed a low SAAG, which is atypical for heart failure-related ascites.
  • Further diagnostic imaging was required to determine the underlying cause.

Findings:

  • Triphasic abdominal computed tomography (CT) confirmed the ascites to be portal hypertension-originated.
  • This finding explained the presence of low-SAAG ascites despite severe heart failure.
  • The case illustrates a rare presentation of ascites in congestive heart failure.

Implications:

  • Low SAAG in heart failure patients necessitates a broader differential diagnosis, including portal hypertension.
  • Advanced imaging like triphasic abdominal CT is vital for accurate diagnosis in atypical cases.
  • Understanding these rare presentations improves patient management and diagnostic strategies for ascites.

Keywords:
ascitesheart failurelow serum-ascites albumin gradientsaagtriphasic abdominal computed tomography

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