An Unusual Cause of Abdominal Ascites

Our plain-English summary of An Unusual Cause of Abdominal Ascites, by K.A. Wong, K.A. Olson, E.W. Chak (Case Reports in Gastroenterology, 2018).

The study

• Authors: K.A. Wong, K.A. Olson, E.W. Chak
• Journal: Case Reports in Gastroenterology
• Published: 2018;12(2):420-424
• Type of article: Case report
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Abdominal ascites is most commonly caused by portal hypertension from liver cirrhosis. When present, portal hypertension is associated with an elevated serum-ascites albumin gradient (SAAG) ≥1.1 g/dL. In contrast, a SAAG < 1.1 g/dL suggests malignancy, tuberculosis, pancreatitis, or nephrotic syndrome. Here, we present a case of low SAAG ascites caused by epithelioid peritoneal mesothelioma in a woman with no known liver disease. The diagnosis proved elusive until diagnostic laparoscopy with biopsy was performed.

In plain English

This article was a case report about one patient. A 73-year-old woman with no history of liver disease had 5 weeks of abdominal swelling caused by fluid buildup (ascites). The report states she had no history of smoking, alcohol abuse, or direct exposure to asbestos. Fluid removed from her abdomen showed a serum-ascites albumin gradient (SAAG) of 0.5 g/dL, a low value that the authors note suggests causes such as malignancy rather than liver-related pressure. Tests of the fluid were negative for cancer cells. Imaging tests did not explain the fluid. A liver biopsy showed normal liver tissue without fibrosis. A chest CT showed scarring and pleural nodules that a later scan suggested were benign. She needed repeated fluid drainage despite medication. Diagnostic laparoscopy, a camera examination of the abdomen, finally showed widespread deposits on the abdominal lining. Biopsies showed low-grade malignancy consistent with mesothelioma, described as epithelioid peritoneal mesothelioma. Chemotherapy and possible surgery were planned. The authors reported that the diagnosis was obtained only after laparoscopy with biopsy.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient)
• Who was studied: one 73-year-old woman with a 5-week history of abdominal swelling, referred to a hepatology (liver) clinic, with no history of liver disease
• Exposure: The report states the patient had no history of direct asbestos exposure. No fiber type, product or job is described.
• Main results:
  • The patient's abdominal fluid had a SAAG of 0.5 g/dL and total protein of 6.4 g/dL
  • Testing of the patient's abdominal fluid was negative for malignancy
  • Imaging did not reveal the cause of the patient's ascites
  • A chest CT showed scarring at the tops of both lungs with pleural and subpleural nodules; a later PET scan suggested these nodules were benign
  • The patient's liver biopsy showed normal liver tissue without fibrosis
  • Repeated fluid drainage was needed despite oral diuretics
  • Diagnostic laparoscopy showed diffuse peritoneal studding, and peritoneal biopsies showed low-grade malignancy consistent with mesothelioma
  • Chemotherapy and possible cytoreductive surgery were planned for the patient
• The authors' conclusion: The authors reported that the diagnosis of epithelioid peritoneal mesothelioma in this patient was obtained only after laparoscopy, which allowed direct viewing of the abdominal lining and biopsy

Topics

Medical terms in this study, explained in our Lexicon: Ascites, Epithelioid, Peritoneal Mesothelioma, Diagnostic Laparoscopy, Biopsy.

Related studies

• Peritoneal Mesothelioma: An Unusual Cause of High-Protein Ascites — M. Kaspar (2015)
• "Signet-ring" cells--a caveat in the diagnosis of a diffuse peritoneal mesothelioma occurring in a lady presenting with recurrent ascites: an unusual case report — B. Rekhi, S. Pathuthara, et al. (2010)
• An unusual case of ascites: pitfalls in diagnosis of malignant peritoneal mesothelioma — J.R. Clark, W.B. Ross (2000)
• Unusual abdominal tumor: peritoneal mesothelioma — P.Y. Su, Y.Y. Chen, et al. (2011)
• Malignant peritoneal mesothelioma as a rare cause of ascites: a case report — I. Ahmed, A. Koulaouzidis, et al. (2008)
• Malignant Peritoneal Mesothelioma: A Rare Cause of Ascites — A.M. Ibrahim, M. Al-Akchar, et al. (2018)

Browse more research in Case Reports in Gastroenterology, or return to medical research.