American Journal of Medical Sciences and Medicine
ISSN (Print): 2327-6681 ISSN (Online): 2327-6657 Website: Editor-in-chief: Apply for this position
Open Access
Journal Browser
American Journal of Medical Sciences and Medicine. 2015, 3(3), 36-38
DOI: 10.12691/ajmsm-3-3-3
Open AccessCase Report

Chylous Ascites as a Rare Manifestation of Congestive Cardiac Failure in a District Hospital

Ganesh Kasinathan1, , Mohd Shafiq Rahman1 and Sirajudeen Rowther1

1Department of Internal Medicine, Segamat Hospital, KM 6 Jalan Genuang, 85000 Segamat, Johor, Malaysia

Pub. Date: August 21, 2015

Cite this paper:
Ganesh Kasinathan, Mohd Shafiq Rahman and Sirajudeen Rowther. Chylous Ascites as a Rare Manifestation of Congestive Cardiac Failure in a District Hospital. American Journal of Medical Sciences and Medicine. 2015; 3(3):36-38. doi: 10.12691/ajmsm-3-3-3


Chylous ascites is an uncommon type of ascites which may be associated with liver diseases, tuberculosis or malignancy. However, in a minority of cases, it is due to heart failure. This case report describes a 59 year old Malay gentleman who presented with multiple episodes of abdominal distension for the past six months associated with exertional dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea and bilateral leg swelling. He denied having any fever, night sweats, anorexia or loss of weight. He did not exhibit any altered bowel habit or vomiting. Physical examination revealed a non tender, distended abdomen with an everted umbilicus. His legs were swollen bilaterally till the knees. Jugular venous pulsations were raised. Lungs revealed bibasal crepitations. Abdominal paracentesis showed milky turbid appearing peritoneal fluid. Laboratory studies revealed an exudative chylous ascites. Tuberculous workout, serum tumor markers and viral hepatitis screening were negative. His transthoracic echocardiogram revealed global hypokinesia with a left ventricular ejection fraction of 30%. Contrast Enhanced Computed Tomography scan of the thorax, abdomen and pelvis showed features consistent of liver cirrhosis with portal hypertension most probably attributable to the severe heart failure. There was no evidence to suggest malignancy. He was started on anti-heart failure drugs in which his ascites showed significant improvement within three months. Congestive cardiac failure should be considered as one of the causes for chylous ascites.

ascites swelling abdomen chylous turbid

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  A. Cárdenas and S. Chopra. “Chylous ascites.” American Journal of Gastroenterology 2002; vol. 97, no. 8, pp. 1896-1900.
[2]  Ezequiel Ridruejo et. al. Chylous ascites as main manifestation of left ventricular dysfunction. A case report. BMC Gastroenterology; 2005; 5:25.
[3]  Hurley MK, Emiliani VJ, Comer GM et. al. Dilated cardiomyopathy associated with chylous ascites. Am J Gastroenterol; 1989; 84: 1567-1569.
[4]  Hüseyin Altuğ Çakmak et. al. Development of chylothorax and chylous ascites in a patient with congestive heart failure. Arch Turk Soc Cardiol. 2011; 39(6):495-49.
[5]  Min-Huang Hsieh, M.D. Chylous Ascites as a Manifestation of Thyrotoxic cardiomyopathy in a Patient with Untreated Graves’ disease. Mary Ann Liebert, Inc. 2010; Vol 20, Number 6.
[6]  Thaworn Subtaweesin, M.D. Chylous Ascites caused by Lutembacherûs Syndrome: A Case Report and Review of the Literature. Siriraj Med J. 2008; 60:78-80.
[7]  D. C. Steinemann, D. Dindo, P.A. Clavien et. al. “Atraumatic chylous ascites: systematic review on symptoms and causes.” Journal of the American College of Surgeons 2011; vol. 212, no. 5, pp. 899-905.
[8]  Dumont AE, Clauss RH, Reed GA et. al. Lymph drainage in patients with congestive heart failure: comparison with findings in hepatic cirrhosis. N Engl J M.1963; 269: 949-952.
[9]  Moller S, Bernardi M. Interactions of the heart and the liver. Eur Heart J. 2013 Sep. 34(36):2804-11.