Differential diagnosis of ascites – Case report:

Introduction: Ascites, the accumulation of intraperitoneal fluid can caused by many factors. Hepatic cirrhosis or neoplasm are the most common reasons (in more than 90% of cases), however several infectious diseases, pancreatitis or nephrosis can lead to it, too. In cardiological respect the most important diseases to preclude are the congestion heart failure and constrictive pericarditis. Investigation of ascites etiology is based of laboratory (exsudate vs. transsudate, microbiology, cytology) and radiology tests.

Case: A 80-years-old woman having dyspnoe and pathologically increased abdominal circumference, with known hypertension, acute pancreatitis, dyspnoe because of hearth failure, peripheral oedema in anamnesis was admitted to our ward. At admission congestive hearth failure was suggested behind his symptoms, chest X-ray test illustrated cardiomegaly and minimal pleural fluid. Abdominal ultrasound test showed large amount of ascites without any laesion. Echocardiography proved good left ventricule function and left ventricule hypertrophy, suspected diastolic heart failure. However ascites and dyspnoe, general well-being of patient got worse after parenteral diuretic therapy, ACE-inhibitors and beta-blockers. According to clinical status and performed proBNP examination heart failure was excluded. Because of progression of ascites a diagnostic punction and lab tests were performed showing high protein and LDH level. High CA-125 suggested abdominal mass in the background so a computer tomography test was organized showing ovarial tumor and peritoneal carcinosis. Citology finally proved malignancy.

Summary: Differenzial diagnostics of ascites can be difficult in cases with co-morbidity with more than one potential reasons. It is suggested to screen for all possible reasons in cases of therapy refracter ascites.