Acute Pulmonary Edema and Cardiac Arrest After Large-Volume Paracentesis in a Patient With Decompensated Cirrhosis

Large-volume paracentesis is a well-established and generally safe treatment for refractory ascites in cirrhosis, with serious complications rarely reported. We describe a woman in her 40s with decompensated alcohol-related cirrhosis who developed acute pulmonary edema and respiratory failure on 2 occasions after large-volume paracentesis. The second episode was complicated by cardiac arrest and death despite prolonged intensive care. Proposed mechanisms include re-expansion pulmonary edema from chronic lung collapse, as well as hemodynamic instability and cardiogenic decompensation triggered by abrupt intra-abdominal pressure changes. This case highlights that even routine procedures in cirrhosis may precipitate catastrophic cardiopulmonary complications in select high-risk patients.