eng Science and Education Publishing American Journal of Cardiovascular Disease Research 2024-02-20 9 1 7 9 10.12691/ajcdr-9-1-2 AJCDR2024912 article Kyrillos Girgis MD kyrilos.gamal@gmail.com 1 Kevin Lipat DO 2 Desmond Aroke MD 2 Thomas Nubong MD 2 Rafail Beshai DO 3 Department of Internal Medicine, Newark Beth Israel Medical Center, Newark, New Jersey, USA Department of Cardiovascular Disease, Newark Beth Israel Medical Center, Newark, New Jersey, USA Department of Cardiovascular Disease, Jefferson Health, NJ, Stratford, USA 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. https://pubs.sciepub.com/ajcdr/9/1/2/ajcdr-9-1-2.pdf heart failure congestive hepatopathy unexpected finding gallbladder malignancy abdominal pain