Tense Ascites Causing Extracardiac Compression: A Case Report and Literature Review

Samuel J Apple¹, Justin Lee², Meagan Freeze³, Dahlia Rizk⁴, Andrea Trimmingham³ and Samy I. McFarlane^3,

¹College of Medicine, State University of New York-Downstate -Health Science University, Brooklyn, New York, United States- 11203

²2Division of Cardiovascular Medicine, State University of New York-Downstate -Health Science University, Brooklyn, New York, United States- 11203

³Department of Internal Medicine, State University of New York: Downstate Medical Center, Brooklyn, New York, United States- 11203

⁴Division of Hospital Medicine, Department of Medicine, Mount Sinai Beth Israel, Icahn School of Medicine NY, NY 10003

Cite this paper:
Samuel J Apple, Justin Lee, Meagan Freeze, Dahlia Rizk, Andrea Trimmingham and Samy I. McFarlane. Tense Ascites Causing Extracardiac Compression: A Case Report and Literature Review. American Journal of Medical Case Reports. 2021; 9(8):402-406. doi: 10.12691/ajmcr-9-8-5

Abstract

Constrictive physiology is most commonly caused by pericardial effusions, constrictive pericarditis or large pleural effusions. Rarely, alternative etiologies may cause cardiac compression. In this report, we present a case of a 70-year-old woman with squamous cell carcinoma who was referred by her cardiologist for evaluation of pericardial and pleural effusions found on echocardiography. Initial clinical findings suggesting constrictive pericarditis, However, after further evaluation we determined that tense ascites was the underlying etiology of constrictive physiology in this patient. This diagnosis requires an integrative interpretation of multiple imaging modalities. Our case highlights the interdependent relationship between cardiac and hepatic pathology that needs to be considered on a case by case basis. Additionally, this case underscores the importance of maintaining a high degree of suspicion for extracardiac compression in the setting of cirrhosis, with prompt paracentesis to adequately prevent the life-threatening sequela of cardiac tamponade.

Keywords:
ascites cirrhosis cardiac tamponade constrictive physiology

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References:

[1]	Appleton C, Gillam L, Koulogiannis K. Cardiac Tamponade. Cardiol Clin. 2017 Nov; 35(4): 525-537.
[2]	Al-Ogaili A, Ayoub A, Fugar S, et al. Cardiac tamponade incidence, demographics and in-hospital outcomes: analysis of the National Inpatient Sample database. J Am Coll Cardiol. 2018; 71(11 suppl): A1155.
[3]	Sagrista-Sauleda J, Merce J, Permanyer-Maralda G, et al. Clinical clues to the causes of large pericardial effusions. Am J Med 2000; 109:95.
[4]	Corey GR, Campbell PT, VanTrigt P, et al. Etiology of large pericardial effusion. Am J Med 1993; 95: 209.
[5]	Levy PY, Corey R, Berger P, et al. Etiologic diagnosis of 204 pericardial effusion. Medicine (Baltimore) 2003; 82: 385.
[6]	Ma W, Liu J, Zeng Y, et al. Causes of moderate to large pericardial effusion requiring pericardiocentesis in 140 Han Chinese patients. Herz 2012; 37: 183.
[7]	Strobbe A, Adriaenssens T, Bennett J, et al. Etiology and long-term outcome of patients undergoing pericardiocentesis. J Am Heart Assoc 2017; 6: e007598.
[8]	Kyriakakis C, Herbst P and Doubell A. (2017): Constrictive pericarditis – prevalence, causes and clinical presentation. European Society of Cardiology, 15(22): 1-8.
[9]	Imazio M, Brucato A, Maestroni S, Cumetti D, Belli R, Trinchero R, Adler Y. Risk of constrictiv pericarditis after acute pericarditis. Circulation 2011; 124: 1270-1275.
[10]	D'Cruz IA, Kleinman D. Extracardiac causes of paradoxical motion of the left ventricular wall. American Heart Journal. 1988 Feb; 115(2): 473-475.
[11]	Swan P, Wu F, Dahle TG, Duprez DA. Extrapericardial Cardiac Compression Syndrome. International Journal of Cardiology. 113.2 (2006): 285-87.
[12]	Ahmad S, Jamali H, K, Waqar F, Harris D, M: Cardiac Tamponade Physiology Secondary to Tense Ascites. Cardiology 2016; 134: 423-425.
[13]	Venkatram S, Kassis G, Gardezi A, Mallapu S, Diaz-Fuentes G: An unusual case of tense ascites causing tamponade physiology. American Thoracic Society Meeting Abstracts. Am J Resp Crit Care Med 2010; 181: A6068.