Kyrillos Girgis MD^1,, Kevin Lipat DO², Desmond Aroke MD², Thomas Nubong MD¹, Rafail Beshai DO³

Elevated transaminase and cholestatic enzyme levels are frequently linked to congestive hepatopathy (CH) in the setting of decompensated heart failure. However, other etiologies such hepatitis and acute cholecystitis should still be considered on the differential diagnosis list. Our case describes a very common case of heart failure exacerbation where lab findings may be attributed to CH, however the ultimate diagnosis of gallbladder malignancy was surprising. Our case highlights the importance of performing the workup for elevated liver enzymes in the setting of acute heart failure exacerbation before attributing the cause to CH. Abdominal ultrasound is a cheap and safe tool that should always be considered in cases of elevated transaminases and cholestatic enzymes. It played a pivotal role in the diagnosis of our case.

heart failure, congestive hepatopathy, unexpected finding, gallbladder malignancy, abdominal pain